Pyogenic liver abscess in liver transplant recipient: a warning signal for the risk of recurrence and retransplantation

E Lafont, O Roux, V de Lastours… - Transplant Infectious …, 2020 - Wiley Online Library
E Lafont, O Roux, V de Lastours, S Dokmak, V Leflon, B Fantin, A Lefort
Transplant Infectious Disease, 2020Wiley Online Library
Background Pyogenic liver abscesses in liver transplant recipients (PLA‐LTR) are a rare
disease whose specificities compared with PLA in non‐transplanted patients (PLA‐C) are
unknown. Methods A retrospective case‐control study was conducted in a French academic
hospital from January 1, 2010, to December 31, 2014. Results Among 176 patients
diagnosed with PLA, 14 were LTR; each case was matched with 3 PLA‐C controls by date of
PLA diagnosis and pathophysiological mechanism of PLA. Median time from liver …
Background
Pyogenic liver abscesses in liver transplant recipients (PLA‐LTR) are a rare disease whose specificities compared with PLA in non‐transplanted patients (PLA‐C) are unknown.
Methods
A retrospective case‐control study was conducted in a French academic hospital from January 1, 2010, to December 31, 2014.
Results
Among 176 patients diagnosed with PLA, 14 were LTR; each case was matched with 3 PLA‐C controls by date of PLA diagnosis and pathophysiological mechanism of PLA. Median time from liver transplantation to PLA diagnosis was 34.5 months. Among 14 PLA‐LTR, 8/14 (57.1%) had bacteremia and 10/14 (71.4%) had positive PLA cultures. Most commonly isolated bacteria were Enterobacteriaceae (9/14; 64.3%), Enterococcus spp. (4/14; 28.6%), and anaerobic bacteria (3/14; 21.4%). Clinical, radiological, and microbiological characteristics did not significantly differ between PLA‐LTR and PLA‐C but there was a tendency toward more diabetic patients and a less acute presentation. All but one PLA‐LTR were associated with ischemic cholangitis, whereas this was a rare cause among PLA‐C (13/14 vs 3/42, respectively, P < .001) among patients with PLA‐LTR. In contrast, hepatobiliary neoplasia was rare in PLA‐LTR but frequent in PLA‐C (1/14 vs 24/42, P = .001). No significant difference was found between PLA‐LTR and PLA‐C in terms of duration of antibiotic therapy (6.5 and 6 weeks, respectively), PLA drainage rates (10/14 and 26/42, respectively), or mortality at 12 months after PLA diagnosis (2/14 and 5/42, respectively). Recurrence rates within the first year were observed in 6/14 patients (42.9%), and retransplantation was needed in 5/14 (35.7%).
Conclusions
Occurrence of PLA in LTR is a severe event leading to high risk of recurrence and retransplantation.
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