Bacterial DNA Translocation in the First 100 Liver Transplant Recipient at the HGUA

Abstract

Introduction: Bacterial translocation(BT) is a major cause of morbidity/mortality in cirrhotic patients. Liver transplantation (LT) is a procedure that involves severe changes of microbiota. Evolution of BT after LT is unknown. Aims: Measuring percentage of cirrhotic patients with BT before and after LT; rate of donors with BT; and relationship between BT and post-LT complications. Methods: Donor blood samples were obtained before liver procurement. Recipients blood samples were obtained at 3, 15, and 30 days after LT. Presence of bacterial DNA of intestinal origin, endotoxin, TNF-α and IL-6 were determined. 1st-year complications after LT were collected using Clavien-Dindo. Results: 100 consecutive LT. Age: 57.4±8.1 years. MELD: 16.4±6. Bacterial DNA was detected in blood of 23 recipients before LT, and in 34 after LT. Only 8 donors had bacterial DNA. Levels of endotoxin (1.19±0.32pg/mL), TNF-α (73.26± 33.35 pg/mL) and IL-6(82.44±39.20 pg/mL) of recipients with bacterial DNA was significantly higher than in recipients without bacterial DNA (0.50±0.28 pg/mL), (20.23±20.94 pg/mL) and (23.55±23,31 pg/mL), (p=0.0001, p=0.009, and p= 0.008), respectively. TNF-α levels before LT was the only independent predictive factor for the presence of bacterial DNA in the first month after LT (p=0.015). No relationship was found between bacterial DNA and 1st-year postoperative complications, but 1st-year readmission rate was higher (p= 0.0001). Conclusions: 34% of LT patients showed translocation of bacterial DNA, but this pro-inflammatory state is not linked to an increase of 1st-year complications. LT patients with circulating bacterial DNA have a higher rate of hospital readmissions during the 1st-year.