Infections following transplants are a major cause of morbidity and mortality.
However, few studies have reported the complications of hepatic abscesses.
|Clinical presentation of hepatic abscess was similar to that in non-immunosuppressed patients.|
In this study, researchers from Cleveland, Ohio, conducted a retrospective chart review of all solid-organ transplant recipients between 1990 and 2000.
The team's criteria for diagnosis included parenchymal hepatic lesions, positive cultures from liver aspirates and/or blood cultures, and a compatible clinical presentation.
Of 2175 organ (heart, lung, kidney, liver, pancreas) recipients, 12 were identified who had experienced episodes of hepatic abscess. All these patients were liver transplant recipients.
The research team established that the median time from transplant to hepatic abscess was 386 days.
In addition, they identified the most common predisposing factor as hepatic artery thrombosis (HAT). This occurred in 8 patients. It was diagnosed at an average of 249 days after transplantation.
The clinical presentation of hepatic abscess was similar to that described in non-immunosuppressed patients.
The team found that all but 1 patient showed hypoalbuminemia (<3.5 g/dl).
Those patients with HAT also had significantly elevated lactate dehydrogenase.
The researchers cultured gram-positive aerobic bacteria from 50% of liver aspirates, gram-negative aerobic bacteria from 30%, anaerobes from 10%, and yeasts from 10%.
On average, patients received 6 weeks of intravenous antibiotic therapy.
Catheter drainage was successful in 70% of cases. However, 5 patients required retransplantation.
Overall, 5 of the patients died, a mortality rate of 42%.
Dr Olympia Tachopoulou's team concluded, "Hepatic abscess, a rare complication after liver transplantation, was frequently associated with hepatic artery thrombosis".
"Mortality was higher than in patients who had not undergone transplantation."
"Prolonged antibiotic therapy, drainage, and even retransplantation may be required to improve the outcome in these patients."