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Post-Liver Transplant Surgical Infection Risks Explored

Factors linked to surgical site infections include choledochojejunal procedure, previous transplants

MONDAY, June 16 (HealthDay News) -- In a group of patients who underwent liver transplantation, 8.8 percent developed surgical site infections; certain procedures, previous transplants and amount of transfused blood were all associated with risk of infections, according to research published in the June issue of Liver Transplantation.

Angel Asensio, M.D., of the Universidad Autonoma de Madrid in Spain, and colleagues analyzed data from 1,222 patients who underwent transplantation in a network of Spanish hospitals. The investigators found that 107 patients developed surgical site infections, predominantly incisional infections and peritonitis.

Factors associated with the development of infections included choledochojejunal reconstruction, previous solid organ transplant and transfusion of more than four units of red blood cells, the researchers report. Some evidence suggested that the use of cefazolin alone for prophylaxis was associated with higher risk, thus using cephalosporin as a unique prophylactic agent may not be advised, according to the authors.

"Liver transplantation is a long (approximately six-hour) operation and involves creation of an anastomosis with the biliary and bowel, where bacterial spillage may occur," writes Shimon Kusne, M.D., of Mayo Clinic Arizona in Phoenix, in an accompanying editorial. "One can assume that it would be important to have a prophylactic agent present in the biliary tract, not only in the wound soft tissue. The presence of the prophylactic antibiotic in the bile in an adequate concentration is important, but this could be significantly reduced in biliary obstruction. In such a condition, serum concentration may be more important than biliary concentration of the prophylactic agent."

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