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.	萬真, 呂毅, 于良, 等.肝移植術后并發肝膿腫5例報告[J].西安交通大學學報:醫學版, 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.	汪根樹, 陳規劃, 何曉順, 等.原位肝移植術后肝膿腫的診斷和治療[J].中華肝臟病雜志, 2004, 12(6):335-337.
4.	徐慶祥, 吳亞夫, 仇毓東, 等.肝移植術后并發腹腔膿腫細菌學研究[J].中華肝膽外科雜志, 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.	巫林偉, 郭志勇, 邰強, 等.同一機構5年原位肝移植726例術后并發肝動脈血栓形成14例資料回顧[J].中國組織工程研究與臨床康復, 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.	黃志強.膽道的解剖生理學與肝移植后膽道并發癥[J].中華外科雜志, 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.	盧強, 鐘曉緋, 凌文武, 等.超聲造影在肝移植術后肝動脈血栓診斷中的應用[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, 劉連新, 姜洪池.肝移植后肝動脈血栓形成的危險因素及防治措施[J].中國普外基礎與臨床雜志, 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, 涂強, 喬兵兵, 等.肝移植術后膽道并發癥的病因及內鏡治療(附32例報道)[J].中國普外基礎與臨床雜志, 2014, 21(1):82-84.
25.	陳規劃.再談肝移植術后膽道并發癥的防治[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.	羅振超, 陳立言, 陳劍尉, 等.肝移植術后膽道并發癥的處理:附258例報告[J].南方醫科大學學報, 2014, 34(5):709-712.

1. 萬真, 呂毅, 于良, 等.肝移植術后并發肝膿腫5例報告[J].西安交通大學學報:醫學版, 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. 汪根樹, 陳規劃, 何曉順, 等.原位肝移植術后肝膿腫的診斷和治療[J].中華肝臟病雜志, 2004, 12(6):335-337.
4. 徐慶祥, 吳亞夫, 仇毓東, 等.肝移植術后并發腹腔膿腫細菌學研究[J].中華肝膽外科雜志, 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. 巫林偉, 郭志勇, 邰強, 等.同一機構5年原位肝移植726例術后并發肝動脈血栓形成14例資料回顧[J].中國組織工程研究與臨床康復, 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. 黃志強.膽道的解剖生理學與肝移植后膽道并發癥[J].中華外科雜志, 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. 盧強, 鐘曉緋, 凌文武, 等.超聲造影在肝移植術后肝動脈血栓診斷中的應用[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, 劉連新, 姜洪池.肝移植后肝動脈血栓形成的危險因素及防治措施[J].中國普外基礎與臨床雜志, 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, 涂強, 喬兵兵, 等.肝移植術后膽道并發癥的病因及內鏡治療(附32例報道)[J].中國普外基礎與臨床雜志, 2014, 21(1):82-84.
25. 陳規劃.再談肝移植術后膽道并發癥的防治[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. 羅振超, 陳立言, 陳劍尉, 等.肝移植術后膽道并發癥的處理:附258例報告[J].南方醫科大學學報, 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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