Infected Bilomas in Liver Transplant Recipients: Clinical Features, Optimal Management, and Risk Factors for Mortality
Open Access
- 15 August 2004
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 39 (4), 517-525
- https://doi.org/10.1086/422644
Abstract
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.This publication has 21 references indexed in Scilit:
- Late hepatic artery thrombosis after orthotopic liver transplantationLiver Transplantation, 2003
- Hepatic abscess after liver transplantation: 1990???2000Transplantation, 2003
- Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantationHepatology, 2002
- TRENDS IN INVASIVE FUNGAL INFECTIONS IN LIVER TRANSPLANT RECIPIENTSTransplantation, 2002
- Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patientsTransplant International, 1998
- Endoscopic retrograde cholangiography in the diagnosis and endoscopic management of biliary complications after liver transplantationEuropean Journal of Gastroenterology & Hepatology, 1996
- American College of Chest Physicians/Society of Critical Care Medicine Consensus ConferenceCritical Care Medicine, 1992
- Variability of clinical presentation of hepatic artery thrombosis in pediatric liver transplantation: Role of imaging modalitiesPediatric Radiology, 1990
- Mortality after orthotopic liver transplantationTransplant International, 1988
- Detection and drainage of bilomas: special considerationsAmerican Journal of Roentgenology, 1983