Evaluation of Clinical Characteristics and Outcomes of Postoperative Infections in Living Liver Donors

Abstract

Aim: To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). Methods: Demographic and clinical charecteristics of 1106 LLDs were retrospectively analysed in terms of whether postoperative infection development. Therefore, LLDs were divided into two group: with (n=190) and without (n=916) antimicrobial agent use. Results: The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma and abscess drainage, and the presences of relaparatomies and transcystic catheters. Infection attacks derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum β-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible Staphylococcus aureus [(MSSA (9.6%)] and Pseudomonas aeruginosae (8.8%), respectively. The average number of ICU hospitalization days was 3±2 (min 1-max 30, IQR:1) and hospitalization days was 14±12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died due to infection or another surgical complication. Conclusion: Infections commonly observed infected biloma, cholangitis and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.

When is it safe for the liver donor to be discharged home and prevent unnecessary re‐hospitalizations? – A systematic review of the literature and expert panel recommendations

“…After review of the titles and abstracts, 57 studies were selected 18–73 . The main features of the studies are reported in Table 1.…”

“…The first outcome was the rate of overall complication, 15 20 , 23 , 24 , 33 , 35 , 48 , 47 , 52 , 59 , 61 , 64 , 68 , 71 , 72 , 73 comparative studies and 10 25 , 28 , 36 , 43 , 45 , 56 , 58 , 60 , 69 , 70 non‐comparative studies were included in the assessment of the QOE. The effect from comparative studies was lower with few events.…”

“…Some 103 full‐text articles were excluded for the following reason: recipients only ( n = 21); not relevant ( n = 55); opinion ( n = 10); case study ( n = 1); pediatric LD ( n = 7); not English ( n = 2); systematic/Lit review ( n = 4); published abstract ( n = 3); duplicates (= 1). In qualitative synthesis, 57 studies were included 18–73 . Studies with less than 50 patients and published more than 10 years ( n = 28) were also excluded of the GRADE.…”

“…The critical outcomes selected by the expert's panel group were complicationsrate and bilirubin or PT/INR peak or value at discharge. Among 57 studies, only 28 studies 20 , 23 – 25 , 28 , 33 , 35 , 36 , 38 , 43 – 47 , 52 , 56 , 58 – 62 , 64 , 68 – 73 were included in qualitative analysis for critical outcomes.…”

“…A grade > III of complications was reported in 20 studies 20 , 23 – 25 , 35 , 43 , 45 , 52 , 56 , 58 , 59 , 61 , 64 , 69 – 73 and ranged from 2.1% 72 to 28% 70 with sample size > 400 patients. Biliary complications (bile leak, strictures, bilioma) were reported in 16 studies 23 , 25 , 28 , 43 , 47 , 52 , 56 , 58 , 59 , 60 , 62 , 69 – 73 . The risk factors for biliary complications were the operation period (RR 2.10, p = .049, 95% CI 1.01–4.39) and the operative time (RR 1.01, 95% CI 1.00–1.02, p = .027) 71 .…”