Decreased immunoglobulin G levels after living-donor liver transplantation is a risk factor for bacterial infection and sepsis.

BACKGROUND: Several studies have suggested an association between post-transplant immunoglobulin (Ig) levels and the development of infection in solid organ transplantation. We therefore conducted exploratory analyses of potential factors associated with bacterial infection/sepsis after living-donor liver transplantation (LDLT). METHODS: Blood samples from 177 recipients who received primary LDLT between September 1999 and November 2011 were available for study. Hypogammaglobulinemia was defined as having at least 1 IgG level <650 mg/dL within 7 days after LDLT. Risk factors for developing post-transplant bacterial infection and sepsis within 3 months after LDLT were analyzed. RESULTS: Fifty (28.2%) recipients experienced bacterial infection within 3 months of LDLT. Eighty-four (47.5%) recipients had hypogammaglobulinemia, although no recipients had hypogammaglobulinemia before LDLT. Hypogammaglobulinemia, undergoing hepaticojejunostomy, and portal pressure at closure >15 mmHg were independent risk factors for developing bacterial infection within 3 months of LDLT (P < 0.0001 P = 0.0008, and P = 0.011, respectively). The odds ratio (OR) and confidence interval (CI) for hypogammaglobulinemia were 4.79 and 2.27-10.7, respectively. Twenty-four (13.6%) recipients developed bacterial sepsis within 3 months. Hypogammaglobulinemia, operative time >14 h, model for end-stage liver disease score >15, and no mycophenolate mofetil use were independent risk factors for developing bacterial sepsis (P = 0.009, P = 0.001, P = 0.003, and P = 0.005, respectively). The OR and CI for hypogammaglobulinemia were 3.83 and 1.38-12.0, respectively. CONCLUSIONS: Hypogammaglobulinemia within 7 days of LDLT was a significant risk factor for post-transplant bacterial infection and sepsis.

Deformation of cavities and resin fillings in loaded teeth.

The purpose of the present work was to study (1) the deformation of selected types of cavities in axially loaded human teeth and (2) the possible effect of this deformation on the restorative quality of fillings in the cavities. Recently extracted wet teeth without any visible structural defects were used throughout the study. Standard Class III and large Class III cavities were prepared in maxillary incisors, while Class I, m-o, m-o-d, and Class V cavities were made in maxillary first premolars. For the second part of the study several of the cavities, etched of non-etched, were filled with restroative resins. Mounted in a measuring microscope the teeth were loaded in a way simulating biting or chewing; cavities with fillings were accepted only when no marginal gaps could be found. The results showed a deformation of empty cavities proportional to the load up to 16 kg, the decrease or increase in diameter being 0.1-1.0 mum/kg, depending on the type of cavity. Loading and unloading of teeth with filled cavities resulted in permanent or transitory gaps. The dimensional instability of cavities in loaded teeth indicates a severe risk of percolation by several restoratives and of marginal fracture of brittle fillings.