Abstract
BackgroundLiver cirrhosis is a well-known risk factor of sepsis after emergent gastrointestinal (GI) endoscopy. Elective GI endoscopy before living donor liver transplantation (LDLT), however, may also carry the septic risk among these patients.MethodsThis retrospective study reviewed the medical records of 642 cirrhotic recipients who underwent GI endoscopy from 2008 to 2016. We analyzed the incidence and risk factors of post-endoscopy sepsis during 2008–2012 (experience cohort). Our protocol changed after 2013 (validation cohort) to include antibiotic prophylaxis.ResultsIn experience cohort, 36 cases (10.5%) of the 342 LDLT candidates experienced sepsis within 48 h after endoscopy. The sepsis rate was significantly higher in patients with hepatic decompensation than patients without (22.2% vs. 9.6% vs. 2.6% in Child C/B/A groups respectively; ×2 = 20.97, P < 0.001). Using multivariate logistic regression analysis, the factors related to post-endoscopy sepsis were the Child score (OR 1.46; 95% CI 1.24–1.71), Child classes B and C (OR 3.80 and 14.13; 95% CI 1.04–13.95 and 3.97–50.23, respectively), hepatic hydrothorax (OR 4.85; 95% CI 1.37–17.20), and use of antibiotic prophylaxis (OR 0.08; 95% CI 0.01–0.64). In validation cohort, antibiotics were given routinely, and all cases of hepatic hydrothorax (n = 10) were drained. Consequently, 4 (1.3%) episodes of sepsis occurred among 300 LDLT candidates, and the incidence was significantly lower than before (1.3% vs. 10.5%, P < 0.001).ConclusionsPatients with decompensated cirrhosis and hepatic hydrothorax have higher risk of sepsis following endoscopy. In advanced cirrhotic patients, antibiotic prophylaxis and drainage of hydrothorax may be required to prevent sepsis before elective GI endoscopy.
Highlights
Liver cirrhosis has become one of the major causes of mortality and morbidity, and liver transplantation (LT) provides the most effective surgical treatment [1, 2].According to the guidelines of the United Network for Organ Sharing and American Association for the Study of Liver Disease, it is mandatory that the presence of extrahepatic malignancy be excluded in LT candidates before surgery [3, 4]
After the approval of the hospital’s institutional review board (IRB no. 201800328B0), we retrospectively reviewed the records of all adults (> 18 years old) who received living donor liver transplantation (LDLT) between September 2008 and December 2012 to determine the incidence and risk factors of sepsis associated with GI endoscopy before transplant surgery
The majority of the patients had chronic HBV infection (n = 287, 43.9%) or hepatocellular carcinoma (HCC) (n = 371, 56.7%), which was the main indication for LDLT
Summary
Liver cirrhosis has become one of the major causes of mortality and morbidity, and liver transplantation (LT) provides the most effective surgical treatment [1, 2].According to the guidelines of the United Network for Organ Sharing and American Association for the Study of Liver Disease, it is mandatory that the presence of extrahepatic malignancy be excluded in LT candidates before surgery [3, 4]. The reason for exclusion comes from the Cincinnati Transplant Tumor Registry study by Penn et al in 1997. Observation data were obtained from more than 1000 renal transplant recipients with history of malignancy, which showed a 22%. Chan et al BMC Gastroenterology (2022) 22:54 recurrence rate after transplantation [5]. Transplant recipients under immunosuppression drugs have increased risks of cancer recurrence, so surveying for extrahepatic malignancy with at least a 5-year tumor-free interval is recommended [7]. Liver cirrhosis is a well-known risk factor of sepsis after emergent gastrointestinal (GI) endoscopy. Elective GI endoscopy before living donor liver transplantation (LDLT), may carry the septic risk among these patients
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