Bacterial translocation after liver transplantation is associated with biliary complications
J.W. Selten, F.J.M. Roos, C.J. Verhoeven, H.J. Metselaar, J.N.M Ijzermans, L.J.W. van der Laan
Chair(s): Dr. B.G. Hepkema
Thursday 9 march 2017
12:30 - 12:45h
Categories: Poster - Basaal
Parallel session: Postersessie - Basaal 1
Introduction:
The intestinal microbiome and the translocation of intestinal bacteria to the portal circulation are more and more recognized as an important pathogenic factor in liver diseases like alcoholic and non-alcoholic liver diseases. The role of microbiota translocation in liver transplantation outcomes, including biliary complications, has not been established. Therefore, the aim of this study is to investigate the incidence of bacteremia after liver transplantation and explore a link with biliary complications.
Methods:
From 1989 – 2010 all liver transplants were analyzed retrospectively for donor and recipient characteristics and positive bacterial cultures in blood. Overall 365 patients were included. Biliary complications comprised of anastomotic strictures (AS), non-anastomotic strictures (NAS) and recurrence of primary sclerosing cholangitis (PSC).
Results:
Of 365 transplants, 68 patients had positive blood cultures (18.6%). Prevalent microbes were Enterococcus faecalis, Staphylococcus aureus and Pseudomonas aeruginosa (33.3%, 20.8% and 16.7%). PSC recurrence was diagnosed in 13 patients out of 66 PSC patients. Positive cultures were 37% in non-recurrent PSC patients and 61% in the recurrence group (p=0.001). NAS was diagnosed in 43 patients of which 25 patients (58%) had positive cultures. In the non-NAS group (n=322), only 43 had positive cultures (13%, p=0.001). Multivariate analysis showed positive blood cultures, re-transplantation and the longer warm ischemia times as independent risk factors for NAS. AS was not associated with positive cultures after transplantation, suggesting a different etiology.
Conclusion:
Bacterial translocation occurs in approximate 20% of recipients after liver transplantation and is associated with an increased risk of biliary complications. No association between AS and positive blood cultures was found, suggesting a difference in etiology between anastomotic strictures and NAS or recurrence of PSC.
