Liver-biopsy-related infection in liver transplant recipients: A current matter of concern?

Liver Transplantation

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Liver Transplantation

C. López MD^1,*, J. Gavaldà PhD¹, I. Bilbao PhD², L. Castells PhD³, A. Gelabert MD⁴,  H. Allende PhD⁵, A. Pahissa PhD¹, O. Len PhD¹

DOI: 10.1002/lt.23817

©2014. American Association for the Study of Liver Diseases

Publication History
Accepted manuscript online: 7 JAN 2014 04:49AM EST
Manuscript Accepted: 22 DEC 2013
Manuscript Revised: 4 DEC 2013
Manuscript Received: 6 OCT 2013

Keywords: prophylaxis;  transjugular biopsy;  sepsis;  transplantation;  albumin

Abstract

Data from published studies regarding risk factors for liver-biopsy related infectious complications in liver transplant recipients are inconsistent. We carried out a retrospective cohort study analyzing consecutive liver biopsies in orthotopic liver transplant patients in a tertiary hospital (2001-2011), including 667 liver biopsies (575 percutaneous and 92 transjugular) in 286 liver transplant recipients. There were 20 complications in 19 patients (overall incidence 3.0%), 10 of which were infectious complications: 8 cases of bacteraemia, and 2 peritonitis. The causal microorganisms, were mainly Pseudomonas aeruginosa (4 patients) and Enterobacteriaceae (4 patients). All complications occurred in biopsies performed in patients hospitalized for more than 48 hours (381 biopsies in 201 patients); hence, only this group was included in the risk factor analysis. The variables associated with the development of infectious complications after liver biopsy were the presence of impaired biliary drainage at the time of biopsy (40% vs 15.1%, p=0.03) and low albumin levels (2.4 mg/dL vs 3.1 mg/dL p=0.01). In conclusion, based on our experience, infectious complications secondary to liver biopsy in liver transplant recipients are related to hospitalization at the time of biopsy, particularly in the presence of impaired biliary drainage and low albumin levels. Liver Transpl , 2013. © 2013 AASLD.

Source

Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: A randomized double-blind study

Journal of Hepatology
Volume 59, Issue 6 , Pages 1184-1192, December 2013

Macarena Simón-Talero, Rita García-Martínez, Maria Torrens, Salvador Augustin, Susana Gómez, Gustavo Pereira, Mónica Guevara, Pere Ginés,  Germán Soriano, Eva Román, Jordi Sánchez-Delgado, Roser Ferrer, Juan C. Nieto, Pilar Sunyé, Inma Fuentes, Rafael Esteban,Juan Córdoba

Received 17 April 2013; received in revised form 4 July 2013; accepted 7 July 2013. published online 22 July 2013.

Abstract

Background & Aims

Episodic hepatic encephalopathy is frequently precipitated by factors that induce circulatory dysfunction, cause oxidative stress-mediated damage or enhance astrocyte swelling. The administration of albumin could modify these factors and improve the outcome of hepatic encephalopathy. The aim of this study is to assess the efficacy of albumin in a multicenter, prospective, double-blind, controlled trial (ClinicalTrials.gov number, NCT00886925).

Methods

Cirrhotic patients with an acute episode of hepatic encephalopathy (grade II–IV) were randomized to receive albumin (1.5g/kg on day 1 and 1.0g/kg on day 3) or isotonic saline, in addition to the usual treatment (laxatives, rifaximin 1200mg per day). The primary end point was the proportion of patients in which encephalopathy was resolved on day 4. The secondary end points included survival, length of hospital stay, and biochemical parameters.

Results

Fifty-six patients were randomly assigned to albumin (n=26) or saline (n=30) stratified by the severity of HE. Both groups were comparable regarding to demographic data, liver function, and precipitating factors. The percentage of patients without hepatic encephalopathy at day 4 did not differ between both groups (albumin: 57.7% vs. saline: 53.3%; p>0.05). However, significant differences in survival were found at day 90 (albumin: 69.2% vs. saline: 40.0%; p=0.02).

Conclusions

Albumin does not improve the resolution of hepatic encephalopathy during hospitalization. However, differences in survival after hospitalization suggest that the development of encephalopathy may identify a subgroup of patients with advanced cirrhosis that may benefit from the administration of albumin.

Abbreviations: HE, hepatic encephalopathy, ACLF, acute-on-chronic liver failure, ALB, albumin group, SAL, saline group, CHESS, clinical hepatic encephalopathy staging scale, HESA, hepatic encephalopathy scoring algorithm, TNF-α, tumor necrosis factor alpha, IL, interleukin,MDA, malondialdehyde, MELD, Model for End-Stage Liver Disease

Keywords: Albumin, Hepatic encephalopathy, Treatment, Cirrhosis, Human

Source

Findings Confirm Benefits of Albumin in Treating Cirrhosis Patients Undergoing Large-Volume Paracentesis

PRESS RELEASE

March 28, 2012, 2:29 p.m. EDT

KING OF PRUSSIA, Pa., March 28, 2012 /PRNewswire via COMTEX/ -- Administration of albumin reduces morbidity and mortality in cirrhotic patients undergoing large-volume paracentesis due to severe ascites, according to a new meta-analysis published online today in Hepatology, the official journal of the American Association for the Study of Liver Diseases. Compared with alternative treatments, albumin, a natural plasma-derived protein that expands blood plasma volume, significantly reduced the circulatory dysfunction that often occurs after large-volume paracentesis and also significantly reduced the occurrence of hyponatremia (low blood sodium levels). In addition, risk of death was 36 percent lower in patients receiving albumin than in those receiving other treatments.

"Albumin is the gold standard for preventing circulatory dysfunction following paracentesis greater than five liters. However, other volume expanders as well as vasoconstrictors have been considered as potential alternatives," said Mauro Bernardi, M.D., Professor of Internal Medicine at Bologna University, Bologna, Italy and lead author of the meta-analysis. "Our findings, which combine all the available evidence from randomized clinical trials, confirm that albumin is the best choice for prevention of circulatory dysfunction, and for the first time show decreased incidence of hyponatremia and improved survival with albumin use."

Within 10 years of receiving a diagnosis, the majority of patients with liver cirrhosis develop ascites, or fluid accumulation in the abdominal cavity. Symptoms include abdominal swelling, major discomfort and impaired breathing often necessitating hospitalization. Patients with ascites have a poor prognosis, with a 50 percent mortality rate over two years. To relieve the pressure caused by the excessive abdominal fluid, a procedure called paracentesis uses a needle to drain the fluid from the abdominal cavity. However, the abrupt removal of large amounts of fluid can worsen existing circulatory dysfunction, leading to a reduction in effective volemia that adversely affect the kidney and other organs.

The meta-analysis, which included results from 17 randomized clinical trials with 1,225 total patients, found that albumin reduced the risk of post-paracentesis circulatory dysfunction by 61 percent compared with alternative treatments. The analysis also found that the risk of hyponatremia, a condition associated with worsening brain function and death, was decreased 42 percent with albumin administration compared to other treatments, further supporting the well-accepted clinical practice of infusing albumin as the first choice in adjunctive treatment for patients requiring large-volume paracentesis.

About CSL Behring

CSL Behring is a global leader in the plasma protein biotherapeutics industry. Passionate about improving the quality of patients' lives, CSL Behring manufactures and markets a range of safe and effective plasma-derived and recombinant products and related services. The company's therapies are used in the treatment of immune deficiency disorders, hereditary angioedema, haemophilia, von Willebrand disease, other bleeding disorders and inherited emphysema. Other products are used for the prevention of hemolytic diseases in the newborn, in cardiac surgery, organ transplantation and in the treatment of burns. The company also operates one of the world's largest plasma collection networks, CSL Plasma. CSL Behring is a subsidiary of CSL Limited, a biopharmaceutical company with headquarters in Melbourne, Australia. For more information, visit www.cslbehring.com .

Contact:Sheila A. Burke, Director, Communications & Public RelationsWorldwide Commercial OperationsCSL Behring 610-878-4209 (o)484-919-2618 (c)Sheila.Burke@cslbehring.com 

SOURCE CSL Behring

Source