Peritonitis after liver transplantation

Incidence, risk factors, microbiology profiles, and outcome

Surakit Pungpapong, Salvador Alvarez, Walter C. Hellinger, David J. Kramer, Darrin L. Willingham, Julio C Mendez, Justin H Nguyen, Winston R. Hewitt, Jaime Aranda-Michel, Denise Harnois, Barry G. Rosser, Christopher B. Hughes, Hani P. Grewal, Raj Satyanarayana, Rolland Dickson, Jeffrey L. Steers, Andrew P. Keaveny

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Peritonitis occurring after liver transplantation (PLT) has been poorly characterized to date. The aims of this study were to define the incidence, risk factors, microbiology profiles, and outcome of nonlocalized PLT. This was a retrospective study of 950 cadaveric liver transplantation (LT) procedures in 837 patients, followed for a mean of 1,086 days (range, 104-2,483 days) after LT. PLT was defined as the presence of at least one positive ascitic fluid culture after LT. There were 108 PLT episodes in 91 patients occurring at a median of 14 days (range, 1-102 days) after LT. Significant risk factors associated with the development of PLT by multivariate analysis included pre-LT model for end-stage liver disease score, duration of LT surgery, Roux-en-Y biliary anastomosis, and renal replacement therapy after LT. Biliary complications, intra-abdominal bleeding, and bowel leak/perforation were associated with 34.3%, 26.9%, and 18.5% of episodes, respectively. Multiple organisms, gram-positive cocci, fungus, and multidrug-resistant bacteria were isolated in 61.1%, 92.6%, 25.9%, and 76.9% of ascitic fluid cultures, respectively. The 28 fungal PLT episodes were associated with bowel leak/perforation and polymicrobial peritonitis. Patients who developed PLT after their first LT had a significantly greater risk of graft loss or mortality compared to unaffected patients. Parameters significantly associated with these adverse outcomes by multivariate analysis were recipient age at LT and bowel leak or perforation after LT. In conclusion, PLT is a serious infectious complication of LT, associated with significant intra-abdominal pathology and reduced recipient and graft survival.

Original languageEnglish (US)
Pages (from-to)1244-1252
Number of pages9
JournalLiver Transplantation
Volume12
Issue number8
DOIs
StatePublished - Aug 2006

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Microbiology
Peritonitis
Liver Transplantation
Incidence
Ascitic Fluid
Multivariate Analysis
Roux-en-Y Anastomosis
Gram-Positive Cocci
End Stage Liver Disease
Renal Replacement Therapy
Graft Survival
Fungi
Retrospective Studies
Pathology
Hemorrhage
Bacteria
Transplants

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Peritonitis after liver transplantation : Incidence, risk factors, microbiology profiles, and outcome. / Pungpapong, Surakit; Alvarez, Salvador; Hellinger, Walter C.; Kramer, David J.; Willingham, Darrin L.; Mendez, Julio C; Nguyen, Justin H; Hewitt, Winston R.; Aranda-Michel, Jaime; Harnois, Denise; Rosser, Barry G.; Hughes, Christopher B.; Grewal, Hani P.; Satyanarayana, Raj; Dickson, Rolland; Steers, Jeffrey L.; Keaveny, Andrew P.

In: Liver Transplantation, Vol. 12, No. 8, 08.2006, p. 1244-1252.

Research output: Contribution to journalArticle

Pungpapong, S, Alvarez, S, Hellinger, WC, Kramer, DJ, Willingham, DL, Mendez, JC, Nguyen, JH, Hewitt, WR, Aranda-Michel, J, Harnois, D, Rosser, BG, Hughes, CB, Grewal, HP, Satyanarayana, R, Dickson, R, Steers, JL & Keaveny, AP 2006, 'Peritonitis after liver transplantation: Incidence, risk factors, microbiology profiles, and outcome', Liver Transplantation, vol. 12, no. 8, pp. 1244-1252. https://doi.org/10.1002/lt.20801
Pungpapong, Surakit ; Alvarez, Salvador ; Hellinger, Walter C. ; Kramer, David J. ; Willingham, Darrin L. ; Mendez, Julio C ; Nguyen, Justin H ; Hewitt, Winston R. ; Aranda-Michel, Jaime ; Harnois, Denise ; Rosser, Barry G. ; Hughes, Christopher B. ; Grewal, Hani P. ; Satyanarayana, Raj ; Dickson, Rolland ; Steers, Jeffrey L. ; Keaveny, Andrew P. / Peritonitis after liver transplantation : Incidence, risk factors, microbiology profiles, and outcome. In: Liver Transplantation. 2006 ; Vol. 12, No. 8. pp. 1244-1252.
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abstract = "Peritonitis occurring after liver transplantation (PLT) has been poorly characterized to date. The aims of this study were to define the incidence, risk factors, microbiology profiles, and outcome of nonlocalized PLT. This was a retrospective study of 950 cadaveric liver transplantation (LT) procedures in 837 patients, followed for a mean of 1,086 days (range, 104-2,483 days) after LT. PLT was defined as the presence of at least one positive ascitic fluid culture after LT. There were 108 PLT episodes in 91 patients occurring at a median of 14 days (range, 1-102 days) after LT. Significant risk factors associated with the development of PLT by multivariate analysis included pre-LT model for end-stage liver disease score, duration of LT surgery, Roux-en-Y biliary anastomosis, and renal replacement therapy after LT. Biliary complications, intra-abdominal bleeding, and bowel leak/perforation were associated with 34.3{\%}, 26.9{\%}, and 18.5{\%} of episodes, respectively. Multiple organisms, gram-positive cocci, fungus, and multidrug-resistant bacteria were isolated in 61.1{\%}, 92.6{\%}, 25.9{\%}, and 76.9{\%} of ascitic fluid cultures, respectively. The 28 fungal PLT episodes were associated with bowel leak/perforation and polymicrobial peritonitis. Patients who developed PLT after their first LT had a significantly greater risk of graft loss or mortality compared to unaffected patients. Parameters significantly associated with these adverse outcomes by multivariate analysis were recipient age at LT and bowel leak or perforation after LT. In conclusion, PLT is a serious infectious complication of LT, associated with significant intra-abdominal pathology and reduced recipient and graft survival.",
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AU - Pungpapong, Surakit

AU - Alvarez, Salvador

AU - Hellinger, Walter C.

AU - Kramer, David J.

AU - Willingham, Darrin L.

AU - Mendez, Julio C

AU - Nguyen, Justin H

AU - Hewitt, Winston R.

AU - Aranda-Michel, Jaime

AU - Harnois, Denise

AU - Rosser, Barry G.

AU - Hughes, Christopher B.

AU - Grewal, Hani P.

AU - Satyanarayana, Raj

AU - Dickson, Rolland

AU - Steers, Jeffrey L.

AU - Keaveny, Andrew P.

PY - 2006/8

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N2 - Peritonitis occurring after liver transplantation (PLT) has been poorly characterized to date. The aims of this study were to define the incidence, risk factors, microbiology profiles, and outcome of nonlocalized PLT. This was a retrospective study of 950 cadaveric liver transplantation (LT) procedures in 837 patients, followed for a mean of 1,086 days (range, 104-2,483 days) after LT. PLT was defined as the presence of at least one positive ascitic fluid culture after LT. There were 108 PLT episodes in 91 patients occurring at a median of 14 days (range, 1-102 days) after LT. Significant risk factors associated with the development of PLT by multivariate analysis included pre-LT model for end-stage liver disease score, duration of LT surgery, Roux-en-Y biliary anastomosis, and renal replacement therapy after LT. Biliary complications, intra-abdominal bleeding, and bowel leak/perforation were associated with 34.3%, 26.9%, and 18.5% of episodes, respectively. Multiple organisms, gram-positive cocci, fungus, and multidrug-resistant bacteria were isolated in 61.1%, 92.6%, 25.9%, and 76.9% of ascitic fluid cultures, respectively. The 28 fungal PLT episodes were associated with bowel leak/perforation and polymicrobial peritonitis. Patients who developed PLT after their first LT had a significantly greater risk of graft loss or mortality compared to unaffected patients. Parameters significantly associated with these adverse outcomes by multivariate analysis were recipient age at LT and bowel leak or perforation after LT. In conclusion, PLT is a serious infectious complication of LT, associated with significant intra-abdominal pathology and reduced recipient and graft survival.

AB - Peritonitis occurring after liver transplantation (PLT) has been poorly characterized to date. The aims of this study were to define the incidence, risk factors, microbiology profiles, and outcome of nonlocalized PLT. This was a retrospective study of 950 cadaveric liver transplantation (LT) procedures in 837 patients, followed for a mean of 1,086 days (range, 104-2,483 days) after LT. PLT was defined as the presence of at least one positive ascitic fluid culture after LT. There were 108 PLT episodes in 91 patients occurring at a median of 14 days (range, 1-102 days) after LT. Significant risk factors associated with the development of PLT by multivariate analysis included pre-LT model for end-stage liver disease score, duration of LT surgery, Roux-en-Y biliary anastomosis, and renal replacement therapy after LT. Biliary complications, intra-abdominal bleeding, and bowel leak/perforation were associated with 34.3%, 26.9%, and 18.5% of episodes, respectively. Multiple organisms, gram-positive cocci, fungus, and multidrug-resistant bacteria were isolated in 61.1%, 92.6%, 25.9%, and 76.9% of ascitic fluid cultures, respectively. The 28 fungal PLT episodes were associated with bowel leak/perforation and polymicrobial peritonitis. Patients who developed PLT after their first LT had a significantly greater risk of graft loss or mortality compared to unaffected patients. Parameters significantly associated with these adverse outcomes by multivariate analysis were recipient age at LT and bowel leak or perforation after LT. In conclusion, PLT is a serious infectious complication of LT, associated with significant intra-abdominal pathology and reduced recipient and graft survival.

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