Temporary Intra-Operative Portocaval Shunts, Post-Operative Infections, and Mid-Term Survival after Cava-Sparing Liver Transplantation.

Abstract

BACKGROUND:

Temporary intra-operative portocaval shunts (TPCS) are believed to improve outcomes after cava-sparing liver transplantation. We hypothesize that decompression of the portal venous system via a TPCS reduces gut congestion, thereby decreasing bacterial translocation. Thus, we sought to clarify whether transplantation with a TPCS alters rates of post-operative infections and survival.

PATIENTS AND METHODS:

Patients undergoing liver transplantation (n = 189) were stratified by usage of a TPCS and the type of intra-operative antibiotic prophylaxis. Rates of post-operative infections were analyzed using the χ2 test. The log-rank test was used to compare 120-d survival.

RESULTS:

The analysis of patients transplanted with a TPCS and meropenem revealed increased infection rates with gut-specific pathogens (Escherichia coli, Escherichia faecalis, Escherichia faecium; p = 0.04) and equal 120-d survival in comparison with patients transplanted without a TPCS. When vancomycin was added to meropenem infection rates did not differ and patients transplanted with a TPCS had better survival in comparison with patients transplanted without a TPCS (p = 0.02). Within the TPCS group, the administration of meropenem and vancomycin was associated with improved survival in comparison with meropenem only (p = 0.03).

CONCLUSION:

Survival of patients may be improved by usage of a TPCS when gut-specific pathogens are covered by intra-operative antibiotic prophylaxis.

• Authors: Maximilian Weniger, Joachim Andrassy, Thomas Weig, Beatrice Grabein, Alexander Crispin, Markus Rentsch, Christian Siebers, Alexandr Bazhin, Jan G D'Haese, Werner Hartwig, Jens Werner, Markus Guba, Eugen Faist, Sebastian Pratschke, Martin K Angele
• Journal: Surgical infections (Surg Infect (Larchmt)) Vol. 18 Issue 7 Pg. 803-809 (Oct 2017) ISSN: 1557-8674 [Electronic] United States
• PMID: 28771110 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis (mortality, statistics & numerical data)
• Humans
• Liver Transplantation (adverse effects, methods, mortality, statistics & numerical data)
• Middle Aged
• Organ Sparing Treatments (adverse effects, statistics & numerical data)
• Portacaval Shunt, Surgical (mortality, statistics & numerical data)
• Retrospective Studies
• Surgical Wound Infection (epidemiology, prevention & control)
• Survival Analysis