Risk factors and outcomes of pyogenic liver abscess in adult liver recipients: a matched case-control study

Autor: Martin de Santibañes, Cristina Elizondo, Juan Pekolj, Adrián Gadano, Pablo E. Huespe, Matias E. Czerwonko, Sung-Ho Hyon, Eduardo de Santibañes, Laura Barcan
Rok vydání: 2018
Předmět:
Male
Time Factors
Databases
Factual
medicine.medical_treatment
Jejunostomy
030230 surgery
Liver transplantation
Gastroenterology
0302 clinical medicine
Risk Factors
Young adult
Abscess
Cholangiopancreatography
Endoscopic Retrograde
Pyogenic liver abscess
education.field_of_study
Middle Aged
Anti-Bacterial Agents
Treatment Outcome
Liver Abscess
Pyogenic
Drainage
Female
030211 gastroenterology & hepatology
Adult
medicine.medical_specialty
Adolescent
Cholangiopancreatography
Magnetic Resonance
Operative Time
Population
Argentina
Arterial Occlusive Diseases
Risk Assessment
Young Adult
03 medical and health sciences
Internal medicine
Multidetector Computed Tomography
medicine
Humans
education
Aged
Retrospective Studies
Hepatology
business.industry
Case-control study
Thrombosis
Retrospective cohort study
medicine.disease
Liver Transplantation
business
Liver abscess
Zdroj: HPB. 20:583-590
ISSN: 1365-182X
Popis: Adult liver recipients (ALR) differ from the general population with pyogenic liver abscess (PLA) as they exhibit: reconstructed biliary anatomy, recurrent hospitalizations, poor clinical condition and are subjected to immunosuppression. The aim of this study was to identify risk factors associated with PLA in ALR and to analyze the management experience of these patients.Between 1996 and 2016, 879 adult patients underwent liver transplantation (LT), 26 of whom developed PLA. Patients and controls were matched according to the time from transplant to abscess in a 1 to 5 relation. A logistic regression model was performed to establish PLA risk factors considering clusters for matched cases and controls. Risk factors were identified and a multivariate regression analysis performed.Patients with post-LT PLA were more likely to have lower BMI (p = 0.006), renal failure (p = 0.031) and to have undergone retransplantation (p = 0.002). A history of hepatic artery thrombosis (p = 0.010), the presence of Roux en-Y hepatojejunostomy (p 0.001) and longer organ ischemia time (p = 0.009) were independent predictors for the development of post-LT PLA. Five-year survival was 49% (95%CI 28-67%) and 89% (95%CI 78%-94%) for post-LT PLA and no post-LT PLA, respectively (p 0.001).history of hepatic artery thrombosis, the presence of hepatojejunostomy and a longer ischemia time represent independent predictors for the development of post-LT PLA. There was a significantly poorer survival in patients who developed post-LT PLA compared with those who did not.
Databáze: OpenAIRE
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