Temporary intra-operative portocaval shunts, post-operative infections, and mid-term survival after cava-sparing liver transplantation

• Verfasst von: Weniger, Maximilian [VerfasserIn]
• Verfasst von: Bazhin, Alexandr V. [VerfasserIn]
• Titel: Temporary intra-operative portocaval shunts, post-operative infections, and mid-term survival after cava-sparing liver transplantation
• Verf.angabe: 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, and Martin K. Angele
• Jahr: 2017
• Umfang: 7 S.
• Fussnoten: Gesehen am 08.11.2018
• Titel Quelle: Enthalten in: Surgical infections
• Ort Quelle: Larchmont, NY : Liebert, 2000
• Jahr Quelle: 2017
• Band/Heft Quelle: 18(2017), 7, Seite 803-809
• ISSN Quelle: 1557-8674
• DOI: doi:10.1089/sur.2017.036
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1582719144

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.