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Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality.

Publication ,  Journal Article
Safdar, N; Said, A; Lucey, MR; Knechtle, SJ; D'Alessandro, A; Musat, A; Pirsch, J; McDermott, J; Kalayoglu, M; Maki, DG
Published in: Clin Infect Dis
August 15, 2004

BACKGROUND: Infected hepatic fluid collections (bilomas) are a major infectious complication of liver transplantation. Limited data exist on management and outcome of biloma. METHODS: We report a cohort study of 57 liver transplant recipients with posttransplantation bilomas undertaken to identify the clinical features of biloma, management strategies, and outcome. RESULTS: Fever (44%) and abdominal pain (40%) were the most common presenting symptoms, but one-third of patients were asymptomatic; 79% had elevated hepatic enzyme levels. Patients without hepatic artery thrombosis (HAT) had the highest rates of resolution with percutaneous drainage and anti-infective therapy (64%). Retransplantation was necessary in 64% of patients with HAT and biloma. Independent predictors of resolution with nonsurgical therapy were absence of HAT (odds ratio [OR] 7.69; P=.01) and absence of Candida (OR, 9.09; P=.02) or enterococcal infection (OR, 7.69; P=.03). Patients with bilomas had significantly greater mortality (Cox proportional hazard ratio [HR], 2.38; P=.008, by log rank test) and graft loss (HR, 4.31; P<.0001). Predictors of mortality by multivariable analysis included renal insufficiency (OR, 12.51; P=.02) or infection with Candida species (OR, 4.93; P=.03) or gram-negative bacilli (OR, 9.12; P=.01). CONCLUSION: Posttransplantation biloma should be suspected in patients with fever or abdominal pain or abnormalities of hepatic enzymes, and it can be confirmed by computerized tomography and radiographically guided aspiration. Bilomas are most likely to be successfully treated nonsurgically in patients without HAT and without Candida or enterococcus infection.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

August 15, 2004

Volume

39

Issue

4

Start / End Page

517 / 525

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Reoperation
  • Prospective Studies
  • Predictive Value of Tests
  • Microbiology
  • Liver Transplantation
  • Liver Diseases
  • Liver
  • Humans
 

Citation

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Safdar, N., Said, A., Lucey, M. R., Knechtle, S. J., D’Alessandro, A., Musat, A., … Maki, D. G. (2004). Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality. Clin Infect Dis, 39(4), 517–525. https://doi.org/10.1086/422644
Safdar, Nasia, Adnan Said, Michael R. Lucey, Stuart J. Knechtle, Anthony D’Alessandro, Alexandru Musat, John Pirsch, John McDermott, Munci Kalayoglu, and Dennis G. Maki. “Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality.Clin Infect Dis 39, no. 4 (August 15, 2004): 517–25. https://doi.org/10.1086/422644.
Safdar N, Said A, Lucey MR, Knechtle SJ, D’Alessandro A, Musat A, et al. Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality. Clin Infect Dis. 2004 Aug 15;39(4):517–25.
Safdar, Nasia, et al. “Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality.Clin Infect Dis, vol. 39, no. 4, Aug. 2004, pp. 517–25. Pubmed, doi:10.1086/422644.
Safdar N, Said A, Lucey MR, Knechtle SJ, D’Alessandro A, Musat A, Pirsch J, McDermott J, Kalayoglu M, Maki DG. Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality. Clin Infect Dis. 2004 Aug 15;39(4):517–525.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

August 15, 2004

Volume

39

Issue

4

Start / End Page

517 / 525

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Reoperation
  • Prospective Studies
  • Predictive Value of Tests
  • Microbiology
  • Liver Transplantation
  • Liver Diseases
  • Liver
  • Humans