Peritonitis occurring after liver transplantation has been poorly characterized to date.
Dr Andrew Keaveny and colleagues from Florida defined the incidence, risk factors, and outcome of nonlocalized peritonitis occurring after liver transplantation.
The investigative team conducted a retrospective study of 950 cadaveric liver transplantation procedures in 837 patients, followed for a mean of 1086 days after transplant.
Peritonitis occurring after liver transplantation was defined as the presence of at least 1 positive ascitic fluid culture.
There were 108 peritonitis occurring after liver transplantation episodes in 91 patients at a median of 14 days.
Risk factors associated with the development of peritonitis occurring after liver transplantation by multivariate analysis included pre-liver transplant model for end-stage liver disease score.
The investigators found that duration of liver transplant surgery, Roux-en-Y biliary anastomosis, and renal replacement therapy after liver transplant were also risk factors.
| Gram-positive cocci were isolated in 93% of ascitic fluid cultures|
The team noted that biliary complications, intra-abdominal bleeding, and bowel leak/perforation were associated with 34%, 27%, and 19% of episodes, respectively.
Multiple organisms, gram-positive cocci, fungus, and multidrug-resistant bacteria were isolated in 61%, 93%, 26%, and 77% of ascitic fluid cultures, respectively.
The 28 fungal peritonitis after liver transplant episodes were associated with bowel leak/perforation and polymicrobial peritonitis.
The investigators observed that patients who developed peritonitis after their first liver transplantation had a greater risk of graft loss or mortality compared to unaffected patients.
Dr Keaveny's team concludes, “Parameters significantly associated with these adverse outcomes by multivariate analysis were recipient age at liver transplantation, and bowel leak or perforation after liver transplantation.”
“In conclusion, peritonitis occurring after liver transplantation is a serious infectious complication of liver transplantation, associated with significant intra-abdominal pathology and reduced recipient and graft survival.”