Diagnosis and Treatment Experience of Liver Abscess after Liver Transplantation: A Report of 8 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XIONGRi-hui , CAIQiu-cheng , DINGChen , LISong , PANFan , ZHANGKun , ZHANGXiao-jin ,  JIANGYi

Department of Hepatobiliary Surgery, Fuzhou General Hospital of PLA, Fuzhou 350001, Fujian Province, China;

Corresponding author：

JIANGYi, Email: jiangyi8183@163.com

Keywords：

Liver abscess; Liver transplantation; Hepatic artery thrombosis; Hepatic artery stenosis; Biliary complication

DOI：

10.7507/1007-9424.20140361

Video：

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Objective To investigate the clinical characteristics and treatment to improve the prognosis of liver abscess after liver transplantation. Methods Eight cases of liver abscess after liver transplantation who were treated in our hospital from Apr. 1999 to Sep. 2013 were retrospectively analyzed, including clinical presentation, predisposing factors, treatment, and prognosis of outcomes. Results In our group, the incidence of liver abscess after liver transplantation was 2.07% (8/387), and main predisposing factors included biliary complications, hepatic artery complications, and so on. The treatments included sensitive antibiotics therapy, reducing or deactivating immunosuppressant, aspiration and drainage of abscess by the ultrasound guiding, balloon valvuloplasty for biliary stenosis, percutaneous transhepatic cholangial drainage (PTCD), indwelling biliary stents, endoscopic nasobiliary drainage (ENBD), and hepatic resection. All of the 8 cases were followed-up for 3-59 months (median of 23 months), during the follow-up period, 4 cases were cured, 1 case improved, and 3 cases died. Conclusions Hepatic arterial and biliary complications are the most common predisposing factors for liver abscess after liver transplantation. Active prevention and treatment of biliary and hepatic arterial complications after liver transplantation are the key to reduce the occurrence of liver abscess and improve the prognosis of it.

Citation： XIONGRi-hui, CAIQiu-cheng, DINGChen, LISong, PANFan, ZHANGKun, ZHANGXiao-jin, JIANGYi. Diagnosis and Treatment Experience of Liver Abscess after Liver Transplantation: A Report of 8 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(12): 1531-1536. doi: 10.7507/1007-9424.20140361 Copy

1.	万真, 吕毅, 于良, 等.肝移植术后并发肝脓肿5例报告[J].西安交通大学学报:医学版, 2012, 33(4):523-524.
2.	Tachopoulou OA, Vogt DP, Henderson JM, et al.Hepatic abscess after liver transplantation:1990-2000[J].Transplantation, 2003, 75(1):79-83.
3.	汪根树, 陈规划, 何晓顺, 等.原位肝移植术后肝脓肿的诊断和治疗[J].中华肝脏病杂志, 2004, 12(6):335-337.
4.	徐庆祥, 吴亚夫, 仇毓东, 等.肝移植术后并发腹腔脓肿细菌学研究[J].中华肝胆外科杂志, 2010, 16(7):538-540.
5.	Kaplan GG, Gregson DB, Laupland KB.Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess[J].Clin Gastroenterol Hepatol, 2004, 2(11):1032-1038.
6.	Chen H, Zhang Y, Chen YG, et al.Sepsis resulting from Entero-bacter aerogenes resistant to carbapenems after liver transplantation[J].Hepatobiliary Pancreat Dis Int, 2009, 8(3):320-322.
7.	Cowie SE, Yoshida EM, Ryan AG, et al.Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor[J].Transpl Int, 2004, 17(7):379-383.
8.	Kornasiewicz O, Dudek K, Lewandowski Z, et al.Low incidence of hepatic artery thrombosis after hepatic artery reconstruction during liver transplantation[J].Transplant Proc, 2009, 41(8):3138-3140.
9.	Stewart ZA, Locke JE, Segev DL, et al.Increased risk of graft loss from hepatic artery thrombosis after liver transplantation with older donors[J].Liver Transpl, 2009, 15(12):1688-1695.
10.	Heaton ND.Hepatic artery thrombosis:conservative management or retransplantation?[J].Liver Transpl, 2013, 19 Suppl 2:S14-S16.
11.	Bekker J, Ploem S, de Jong KP.Early hepatic artery thrombosis after liver transplantation:a systematic review of the incidence, outcome and risk factors[J].Am J Transplant, 2009, 9(4):746-757.
12.	巫林伟, 郭志勇, 邰强, 等.同一机构5年原位肝移植726例术后并发肝动脉血栓形成14例资料回顾[J].中国组织工程研究与临床康复, 2011, 15(5):936-939.
13.	García-Criado A, Gilabert R, Berzigotti A, et al.Doppler ultrasound findings in the hepatic artery shortly after liver transplantation[J].AJR Am J Roentgenol, 2009, 193(1):128-135.
14.	Han B, Liu C, Tian H, et al.Formation of collateral circulation within hepatic parenchyma after recurrent hepatic artery thrombosis and thrombolysis early after liver transplantation:case report[J].Transplantation, 2009, 87(10):1591-1592.
15.	Yu YD, Kim DS, Byun GY, et al.Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft[J].J Korean Surg Soc, 2012, 83(4):246-249.
16.	黄志强.胆道的解剖生理学与肝移植后胆道并发症[J].中华外科杂志, 2006, 44(5):289-291.
17.	Friedl J, Stift A, Berlakovich GA, et al.Haemophilus parainfluenzae liver abscess after successful liver transplantation[J].J Clin Microbiol, 1998, 36(3):818-819.
18.	卢强, 钟晓绯, 凌文武, 等.超声造影在肝移植术后肝动脉血栓诊断中的应用[J].器官移植, 2014, 5(2):79-84.
19.	Grodzicki M, Anysz-Grodzicka A, Remiszewski P, et al.Treatment of early hepatic artery thrombosis after liver transplantation[J].Transplant Proc, 2011, 43(8):3039-3042.
20.	王晨宇, 刘连新, 姜洪池.肝移植后肝动脉血栓形成的危险因素及防治措施[J].中国普外基础与临床杂志, 2007, 14(5):615-618.
21.	Stange BJ, Glanemann M, Nuessler NC, et al.Hepatic artery thrombosis after adult liver transplantation[J].Liver Transpl, 2003, 9(6):612-620.
22.	Castro e Silva O, Sankarankutty AK, Martinelli AL, et al.Thera-peutic effect of hyperbaric oxygen in hepatic artery thrombosis and functional cholestasis after orthotopic liver transplantation[J].Transplant Proc, 2006, 38(6):1913-1917.
23.	Grover I, Conley L, Alzate G, et al.Hyperbaric oxygen therapy for hepatic artery thrombosis following liver transplantation:current concepts[J].Pediatr Transplant, 2006, 10(2):234-239.
24.	范林, 涂强, 乔兵兵, 等.肝移植术后胆道并发症的病因及内镜治疗(附32例报道)[J].中国普外基础与临床杂志, 2014, 21(1):82-84.
25.	陈规划.再谈肝移植术后胆道并发症的防治[J].器官移植, 2014, 5(1):1-3.
26.	Ribeiro JB, Martins Fde S, Garcia JH, et al.Endoscopic mana-gement of biliary complications after liver transplantation[J].Arq Bras Cir Dig, 2012, 25(4):269-272.
27.	罗振超, 陈立言, 陈剑尉, 等.肝移植术后胆道并发症的处理:附258例报告[J].南方医科大学学报, 2014, 34(5):709-712.

1. 万真, 吕毅, 于良, 等.肝移植术后并发肝脓肿5例报告[J].西安交通大学学报:医学版, 2012, 33(4):523-524.
2. Tachopoulou OA, Vogt DP, Henderson JM, et al.Hepatic abscess after liver transplantation:1990-2000[J].Transplantation, 2003, 75(1):79-83.
3. 汪根树, 陈规划, 何晓顺, 等.原位肝移植术后肝脓肿的诊断和治疗[J].中华肝脏病杂志, 2004, 12(6):335-337.
4. 徐庆祥, 吴亚夫, 仇毓东, 等.肝移植术后并发腹腔脓肿细菌学研究[J].中华肝胆外科杂志, 2010, 16(7):538-540.
5. Kaplan GG, Gregson DB, Laupland KB.Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess[J].Clin Gastroenterol Hepatol, 2004, 2(11):1032-1038.
6. Chen H, Zhang Y, Chen YG, et al.Sepsis resulting from Entero-bacter aerogenes resistant to carbapenems after liver transplantation[J].Hepatobiliary Pancreat Dis Int, 2009, 8(3):320-322.
7. Cowie SE, Yoshida EM, Ryan AG, et al.Hepatic abscesses after liver transplantation secondary to traumatic intrahepatic bile duct injuries in a cadaveric allograft donor[J].Transpl Int, 2004, 17(7):379-383.
8. Kornasiewicz O, Dudek K, Lewandowski Z, et al.Low incidence of hepatic artery thrombosis after hepatic artery reconstruction during liver transplantation[J].Transplant Proc, 2009, 41(8):3138-3140.
9. Stewart ZA, Locke JE, Segev DL, et al.Increased risk of graft loss from hepatic artery thrombosis after liver transplantation with older donors[J].Liver Transpl, 2009, 15(12):1688-1695.
10. Heaton ND.Hepatic artery thrombosis:conservative management or retransplantation?[J].Liver Transpl, 2013, 19 Suppl 2:S14-S16.
11. Bekker J, Ploem S, de Jong KP.Early hepatic artery thrombosis after liver transplantation:a systematic review of the incidence, outcome and risk factors[J].Am J Transplant, 2009, 9(4):746-757.
12. 巫林伟, 郭志勇, 邰强, 等.同一机构5年原位肝移植726例术后并发肝动脉血栓形成14例资料回顾[J].中国组织工程研究与临床康复, 2011, 15(5):936-939.
13. García-Criado A, Gilabert R, Berzigotti A, et al.Doppler ultrasound findings in the hepatic artery shortly after liver transplantation[J].AJR Am J Roentgenol, 2009, 193(1):128-135.
14. Han B, Liu C, Tian H, et al.Formation of collateral circulation within hepatic parenchyma after recurrent hepatic artery thrombosis and thrombolysis early after liver transplantation:case report[J].Transplantation, 2009, 87(10):1591-1592.
15. Yu YD, Kim DS, Byun GY, et al.Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft[J].J Korean Surg Soc, 2012, 83(4):246-249.
16. 黄志强.胆道的解剖生理学与肝移植后胆道并发症[J].中华外科杂志, 2006, 44(5):289-291.
17. Friedl J, Stift A, Berlakovich GA, et al.Haemophilus parainfluenzae liver abscess after successful liver transplantation[J].J Clin Microbiol, 1998, 36(3):818-819.
18. 卢强, 钟晓绯, 凌文武, 等.超声造影在肝移植术后肝动脉血栓诊断中的应用[J].器官移植, 2014, 5(2):79-84.
19. Grodzicki M, Anysz-Grodzicka A, Remiszewski P, et al.Treatment of early hepatic artery thrombosis after liver transplantation[J].Transplant Proc, 2011, 43(8):3039-3042.
20. 王晨宇, 刘连新, 姜洪池.肝移植后肝动脉血栓形成的危险因素及防治措施[J].中国普外基础与临床杂志, 2007, 14(5):615-618.
21. Stange BJ, Glanemann M, Nuessler NC, et al.Hepatic artery thrombosis after adult liver transplantation[J].Liver Transpl, 2003, 9(6):612-620.
22. Castro e Silva O, Sankarankutty AK, Martinelli AL, et al.Thera-peutic effect of hyperbaric oxygen in hepatic artery thrombosis and functional cholestasis after orthotopic liver transplantation[J].Transplant Proc, 2006, 38(6):1913-1917.
23. Grover I, Conley L, Alzate G, et al.Hyperbaric oxygen therapy for hepatic artery thrombosis following liver transplantation:current concepts[J].Pediatr Transplant, 2006, 10(2):234-239.
24. 范林, 涂强, 乔兵兵, 等.肝移植术后胆道并发症的病因及内镜治疗(附32例报道)[J].中国普外基础与临床杂志, 2014, 21(1):82-84.
25. 陈规划.再谈肝移植术后胆道并发症的防治[J].器官移植, 2014, 5(1):1-3.
26. Ribeiro JB, Martins Fde S, Garcia JH, et al.Endoscopic mana-gement of biliary complications after liver transplantation[J].Arq Bras Cir Dig, 2012, 25(4):269-272.
27. 罗振超, 陈立言, 陈剑尉, 等.肝移植术后胆道并发症的处理:附258例报告[J].南方医科大学学报, 2014, 34(5):709-712.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment Experience of Liver Abscess after Liver Transplantation: A Report of 8 Cases

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