Journal Article

Infected Bilomas in Liver Transplant Recipients: Clinical Features, Optimal Management, and Risk Factors for Mortality

Nasia Safdar, Adnan Said, Michael R. Lucey, Stuart J. Knechtle, Anthony D'Alessandro, Alexandru Musat, John Pirsch, John McDermott, Munci Kalayoglu and G. Maki Dennis

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 4, pages 517-525
Published in print August 2004 | ISSN: 1058-4838
Published online August 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/422644
Infected Bilomas in Liver Transplant Recipients: Clinical Features, Optimal Management, and Risk Factors for Mortality

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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.

Journal Article.  4245 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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