Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data.

BACKGROUND: Postoperative infections are frequent complications after liver resection and have significant impact on length of stay, morbidity and mortality. Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, accounting for 38% of all such infections. OBJECTIVES: This study aimed to identify predictors of SSI and organ space SSI after liver resection. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent liver resection in 2005, 2006 or 2007 in any of 173 hospitals throughout the USA were analysed. All patients who underwent a segmental resection, left hepatectomy, right hepatectomy or trisectionectomy were included. RESULTS: The ACS-NSQIP database contained 2332 patients who underwent hepatectomy during 2005-2007. Rates of SSI varied significantly across primary procedures, ranging from 9.7% in segmental resection patients to 18.3% in trisectionectomy patients. A preoperative open wound, hypernatraemia, hypoalbuminaemia, elevated serum bilirubin, dialysis and longer operative time were independent predictors for SSI and for organ space SSI. CONCLUSIONS: These findings may contribute towards the identification of patients at risk for SSI and the development of strategies to reduce the incidence of SSI and subsequent costs after liver resection.

The influence of immunosuppression switching in liver function in adult hepatic transplantation.

We evaluate the 5-year results of a single-centre prospective randomized trial that compared cyclosporine microemulsion (CyA-me) in triple therapy (plus steroids and azathioprine) and Tacrolimus (Tac) in double therapy (plus steroids) for primary immunosuppression. One hundred adult patients undergoing liver transplantation were randomized to receive Tac (n=51) or CyA-me (n=49). Ten patients in group A, and thirty-one patients in group B had their main immunosuppressive agent switched. The switch was much more frequent from CyA-me to Tac (n=31; 62.3%), mainly because of lack of efficacy (n=12; 38.7%). Six of 10 patients were shifted from Tac to CyA-me for side effects. The clinical course of the majority of patients converted from CyA-me to Tac improved clearly after conversion. Donor age and acute rejection (number, severity and rejection free days) had a significative association with lack of efficacy in group B. In these series, the conversion to Tac from CyA-me could be accomplished safely, with an excellent long-term outcome.

Artificial liver support system in acute liver failure patients waiting liver transplantation.

BACKGROUND/AIMS: To assess the efficacy of the Molecular Adsorbent Recirculating System MARS (GAMBRO LUNDIA AB, Europe) in patients with acute liver failure waiting for liver transplantation. METHODOLOGY: Case-control study in a medical-surgical ICU of a referral hospital. Patients admitted to ICU with severe acute liver failure of any etiology were included. Conventional treatment was applied in all cases according to patient's clinical condition. Patients were treated with MARS after the implementation of this therapy in the ICU. Patients without this treatment were the control group. RESULTS: Were included 45 patients (control group: 26, MARS group: 19). Comparison between groups showed only differences in plasma bilirrubin levels in the first 24 hours. ICU mortality was 52.63% in the treatment group and 42.3% in the control group (p = 0.49). In the control group 17 patients (65.4%) received a liver transplant and 11 (57.9%) in the MARS group. ICU mortality was lower for transplanted patients in the study group (27.27% vs. 87.5%) (p = 0.019). Kaplan-Meier survival curves indicate that MARS-treated patients before liver transplantation had better survival. CONCLUSIONS: Combination therapy with MARS and liver transplantation seems to be the more effective therapeutic option for patients with severe ALF.