Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Liver Transpl. 2011 Aug;17(8):976-84. doi: 10.1002/lt.22278.
Infection after pediatric living donor liver transplantation (LDLT) is a major cause of morbidity and mortality. Here, we sought to determine the incidence, timing, location, and risk factors for bacterial and fungal infections. We retrospectively investigated infection for 3 postoperative months in 345 consecutive pediatric patients (56.2% were females) who underwent primary LDLT at Kyoto University Hospital, Japan. A total of 179 patients (51.9%) developed at least 1 bacterial and/or fungal infection episode, with an infection rate of 2.5 per patient. The predominant infection site was the surgical site (52%). Most of the bacterial and fungal infection occurred within the first month. Enterococcus species followed by multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were the predominant bacterial pathogens. All fungal isolates were Candida species. Prolonged preoperative hospital stay more than 7 days (P = 0.025) and bile leak (P = 0.047) were independent predictors of bacterial infection. Preoperative ascites (P = 0.009) and prolonged insertion of intravascular catheters (P = 0.001) independently predicted fungal infections. Bacterial and fungal infections were responsible for 42.9% of the causes of death in our study. To avoid bacterial and fungal infections after LDLT, broader-spectrum prophylaxis to cover the range of organisms seen in these infections should be considered as a more favorable treatment regimen to prevent prophylaxis failure, especially for patients with a preoperative hospital stay more than 7 days or operative complications in the form of a bile leak. Early drain removal and prophylactic antifungal drugs should be considered for patients with preoperative ascites. Cooperation between attending physicians and infectious disease physicians can improve the outcome of patients after LDLT.
在小儿活体肝移植（LDLT）术后，感染是发病率和死亡率的主要原因。在这里，我们旨在确定细菌和真菌感染的发生率、时间、部位和危险因素。我们回顾性调查了日本京都大学医院 345 例连续原发性 LDLT 术后 3 个月的感染情况（56.2%为女性）。共有 179 例（51.9%）患者至少发生了 1 次细菌和/或真菌感染，感染率为 2.5 例/患者。主要感染部位为手术部位（52%）。大多数细菌和真菌感染发生在第 1 个月内。肠球菌属，其次是多重耐药铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌，是主要的细菌病原体。所有真菌分离株均为念珠菌属。术前住院时间延长超过 7 天（P=0.025）和胆漏（P=0.047）是细菌感染的独立预测因素。术前腹水（P=0.009）和血管内导管插入时间延长（P=0.001）是真菌感染的独立预测因素。细菌和真菌感染是导致本研究中 42.9%患者死亡的原因。为了避免 LDLT 术后发生细菌和真菌感染，应考虑更广泛的预防方案，以覆盖这些感染中出现的病原体范围，这可能是一种更有利的治疗方案，以防止预防失败，特别是对于术前住院时间超过 7 天或出现胆漏等手术并发症的患者。对于术前有腹水的患者，应考虑早期拔除引流管和预防性抗真菌药物。主治医生和传染病医生之间的合作可以改善 LDLT 术后患者的预后。
