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Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention.

Publication ,  Journal Article
Said, A; Safdar, N; Lucey, MR; Knechtle, SJ; D'Alessandro, A; Musat, A; Pirsch, J; Kalayoglu, M; Maki, DG
Published in: Am J Transplant
April 2004

Bilomas, infected hepatic fluid collections, are a frequent complication of liver transplantation. We report a case-control cohort study to determine the incidence and microbiologic profile of bilomas and risk factors for biloma formation in 492 patients undergoing liver transplantation from 1994 to 2001. Fifty-seven patients (11.5%) developed one or more bilomas; 95% in the first year post-transplantation. The most common initial infecting pathogens were enterococci (37%), one-half resistant to vancomycin (VRE); coagulase-negative staphylococci (26%); and Candida species (26%). Infection by coagulase-negative staphylococci was strongly associated with the presence of a T-tube (OR 9.60, p=0.02). In stepwise logistic regression multivariable analyses, hepatic artery thrombosis (OR 90.9, p<0.0001), hepatic artery stenosis (OR 13.2, p<0.0001) and Roux-en-Y choledochojejunostomy (OR 5.8, p=0.03) were independent risk factors for biloma formation; ursodeoxycholic acid use was highly protective (OR 0.1, p=0.002). Strategies to prevent biloma formation must focus on measures to prevent hepatic artery thrombosis and colonization of liver transplant patients by multiresistant nosocomial pathogens. T-tube drainage post-transplantation bears reassessment. The protective effect of ursodeoxycholic acid found in this study warrants confirmation in a prospective multicenter, randomized trial.

Duke Scholars

Published In

Am J Transplant

DOI

ISSN

1600-6135

Publication Date

April 2004

Volume

4

Issue

4

Start / End Page

574 / 582

Location

United States

Related Subject Headings

  • Vancomycin
  • Tomography, X-Ray Computed
  • Time Factors
  • Surgery
  • Staphylococcal Infections
  • Risk Factors
  • Odds Ratio
  • Multivariate Analysis
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Said, A., Safdar, N., Lucey, M. R., Knechtle, S. J., D’Alessandro, A., Musat, A., … Maki, D. G. (2004). Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention. Am J Transplant, 4(4), 574–582. https://doi.org/10.1111/j.1600-6143.2004.00374.x
Said, Adnan, Nasia Safdar, Michael R. Lucey, Stuart J. Knechtle, Anthony D’Alessandro, Alexandru Musat, John Pirsch, Munci Kalayoglu, and Dennis G. Maki. “Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention.Am J Transplant 4, no. 4 (April 2004): 574–82. https://doi.org/10.1111/j.1600-6143.2004.00374.x.
Said A, Safdar N, Lucey MR, Knechtle SJ, D’Alessandro A, Musat A, et al. Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention. Am J Transplant. 2004 Apr;4(4):574–82.
Said, Adnan, et al. “Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention.Am J Transplant, vol. 4, no. 4, Apr. 2004, pp. 574–82. Pubmed, doi:10.1111/j.1600-6143.2004.00374.x.
Said A, Safdar N, Lucey MR, Knechtle SJ, D’Alessandro A, Musat A, Pirsch J, Kalayoglu M, Maki DG. Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention. Am J Transplant. 2004 Apr;4(4):574–582.
Journal cover image

Published In

Am J Transplant

DOI

ISSN

1600-6135

Publication Date

April 2004

Volume

4

Issue

4

Start / End Page

574 / 582

Location

United States

Related Subject Headings

  • Vancomycin
  • Tomography, X-Ray Computed
  • Time Factors
  • Surgery
  • Staphylococcal Infections
  • Risk Factors
  • Odds Ratio
  • Multivariate Analysis
  • Middle Aged
  • Male