Infections Complicating Orthotopic Liver Transplantation

An alternative technique of biliary reconstruction after liver transplantation

“…Calne characterized the anastomosis for biliary drainage as the "technical Achilles' heel" of the whole procedure. About 50% of Calne's and Starzl's early human liver transplants and of our first 50 patients developed serious biliary tract complications following either end-to-end choledochocholedochostomy with T-tube drainage or choledochojejunostomy with a Roux-en-Y jejunal loop [4,5,16,12]. Anastomosis leakage led to biliary peritonitis and sepsis in the early course or to stenosis, biliary obstruction, and infection later on [12,15].…”

“…Starzl for a period preferred choledochojejun0stomy with a Roux-en-Yjejunal loop and T-tube drainage [12,16], but returned to direct duct to duct anastomosis to preserve the natural sphincter mechanism.…”

Immunizations and infectious diseases in pediatric liver transplantation

“…For example, LTx recipients undergoing Roux-en-Y choledocoduodenostomy experience more infectious episodes than those who undergo a choledochocholedochostomy with T-tube drainage. 13,14 However, only the former option is usually performed in children because of the small size of their bile ducts or because of requirements associated with technical variants of LTx (eg, split, reduced, and living donor organs). A prolonged operative time (Ͼ12 hours) during the transplant has been associated with an increased risk of infection 13,15 and is likely a surrogate marker for the technical difficulty of the surgery.…”

“…Hepatic artery thrombosis is the most serious technical problem following LTx, predisposing to areas of necrotic liver and the development of hepatic abscesses and bacteremia. 14,16 Bile duct strictures, developing as sequelae of a thrombosed hepatic artery and ischemia or because of technical difficulties, may predispose to cholangitis. 16 Immunosuppression is the critical posttransplant factor predisposing to infection in transplant recipients.…”

“…[28][29][30][31] Rates for bacterial infection of 40% to 70% have been reported. 13,14,19 Bacteremia often occurs in association with intra-abdominal infection or with the use of central venous catheters. Enteric gram-negative organisms account for more than onehalf of episodes.…”