Bacterial Sepsis after Living Donor Liver Transplantation: The Impact of Early Enteral Nutrition

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• 作者：Toru Ikegami ; MD ; ^{tikesurg@yahoo.co.jp} ; Ken Shirabe ; MD ; FACS ; Shohei Yoshiya ; MD ; Tomoharu Yoshizumi ; MD ; Mizuki Ninomiya ; MD ; Hideaki Uchiyama ; MD ; Yuji Soejima ; MD ; Yoshihiko Maehara ; MD ; FACS
• 关键词：DDLT ; deceased donor liver transplantation ; LDLT ; living donor liver transplantation ; GNB ; gram-negative bacteria ; GPB ; gram-positive bacteria ; GRWR ; graft recipient weight ratio ; GV ; graft volume ; MELD ; Model for End-Stage Liver Disease ; PVP ; portal veno
• 刊名：Journal of the American College of Surgeons
• 出版年：2012
• 期刊代码：175_10727515
• 类别：med
• 出版时间：March, 2012
• 卷：214
• 期：3
• 页码：288-295
• 文件大小：573 K

摘要

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Background

Bacterial sepsis is a significant problem that must be addressed after living donor liver transplantation (LDLT).

Study Design

A retrospective analysis of 346 adult-to-adult LDLT patients was performed.

Results

Forty-six patients (13.3%) experienced bacterial sepsis, with primary and secondary origins in 23.9%and 76.1%, respectively. Gram-negative bacteria accounted for 71.7%of the bacteria isolated. The 2-year cumulative graft survival rate in patients with bacterial sepsis was 45.7%. Patients with bacterial sepsis secondary to pneumonia (n = 12) had poorer 2-year graft survival rates (16.7%) than did those with primary or other types of secondary sepsis (p = 0.004). Multivariate analysis showed that intraoperative massive blood loss >10L (p < 0.001) and no enteral feeding started within 48 hours after transplantation (p = 0.005) were significant risk factors for bacterial sepsis. Among patients who received enteral nutrition, the incidences of bacterial sepsis in patients who received enteral nutrition within 48 hours (n = 135) or later than 48 hours (n = 57) were 5.9%and 21.0%, respectively (p = 0.002). The incidence of early graft loss was 8-fold higher in recipients with massive intraoperative blood loss without early enteral nutrition (p < 0.001).

Conclusions

Early enteral nutrition was associated with significantly reduced risk of developing bacterial sepsis after LDLT.