scholarly journals Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection

2021 ◽  
Author(s):  
Ing-Kit Lee ◽  
Yi-Ping Sng ◽  
Wei-Feng Li ◽  
Chao-Long Chen ◽  
Chih-Chi Wang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Transplant Recipients ◽  
Donor Liver ◽  
Level Of Evidence ◽  
Donor Liver Transplantation ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Liver Transplant Recipients ◽  
The Impact

Abstract Background: The prevalence of vancomycin-resistant enterococci (VRE) is increasing among liver transplant recipients. This study aimed to explore the clinical features of liver transplant recipients with VRE infection/colonization and to determine the impact of daptomycin dosage on the outcomes. Methods: We retrospectively enrolled pre-transplant and post-transplant patients with VRE colonization/infection from 2016 to 2019. Results: Altogether, 428 patients underwent liver transplantation. Among these, 22 (5.1%) patients developed VRE colonization/infection. All VRE isolates were Enterococcus faecium. Two (9%) patients acquired VRE in the pre-transplant period, 16 (3 colonizations and 13 infections) (72.7%) in the early post-liver transplant period (≤60-day after transplantation), and 4 (2 colonization and 2 infections) (18.1%) in the late post-liver transplant period (>6-month after transplantation). Among 13 patients with early post-liver transplant VRE infection, 12 (92.3%) underwent living-donor liver transplantation and 1 underwent deceased donor liver transplantation. Among these 13 patients, the median time from transplant to emergence of VRE infection was 12 days. The median interval from VRE infection to death was 27 days and the 30-day mortality was 67%. Of these 13 patients, eleven patients (8 survived; 3 died) received daptomycin therapy for VRE. Among them, 4 (36.3%) received daptomycin doses <8 mg/kg. Non-survivors (n=3) received significantly lower daptomycin dose than survivors (n=8) (P=0.040). Daptomycin doses <8mg/kg were more frequently associated with non-survivors (n=3) than with survivors (n=8) (P=0.024). Conclusions: In summary, the suboptimal dosage of daptomycin may have contributed to a higher rate of in-hospital mortality. Doses ≥8 mg/kg may be needed to adequately treat VRE infection in early post-liver transplant recipients.Level of evidence: Level III

scholarly journals Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G Abdelrahman ◽  
H A Mahmoud ◽  
M K Mohsen ◽  
M O Ali ◽  
A M N Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
Cytomegalovirus Infection ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Donor Liver Transplantation ◽  
Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients. “Vite fait, bien fait.”

2019 ◽  
Vol 103 (8) ◽  
pp. e218-e219 ◽  
Author(s):  
Raffaele Brustia ◽  
Emmanuel Boleslawski ◽  
Jerome Danion ◽  
Eric Savier ◽  
Benoit Barrou ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Deceased Donor ◽  
Extraction Time ◽  
Transplant Recipients ◽  
Adult Liver ◽  
Donor Liver ◽  
Allograft Function ◽  
Liver Transplant Recipients ◽  
The Impact

scholarly journals The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients

2018 ◽  
Vol 102 (11) ◽  
pp. e466-e471 ◽  
Author(s):  
Dieter Adelmann ◽  
Garrett R. Roll ◽  
Rishi Kothari ◽  
Shareef Syed ◽  
Lyle J. Burdine ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Deceased Donor ◽  
Extraction Time ◽  
Transplant Recipients ◽  
Adult Liver ◽  
Donor Liver ◽  
Allograft Function ◽  
Liver Transplant Recipients ◽  
The Impact

scholarly journals Appropriate Vancomycin Use and Incidence of Vancomycin-Resistant Enterococci in Liver Transplant Recipients

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Jessica Ferguson ◽  
Marisa Holubar ◽  
Waldo Concepcion ◽  
Dora Y. Ho ◽  
Keyword(s):  
Liver Transplant ◽  
Retrospective Cohort ◽  
Positive Culture ◽  
Vancomycin Resistant Enterococcus ◽  
Antibiotic Exposure ◽  
Transplant Recipients ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Liver Transplant Recipients ◽  
To Receive

Liver transplant recipients (LTRs) are at risk for vancomycin-resistant Enterococcus (VRE) infections which can lead to significant morbidity or mortality. Antibiotic exposure, including vancomycin, is associated with greater risk of VRE infection. This study aimed to assess the appropriateness of vancomycin use and rates of VRE infection in this population. We performed a retrospective cohort study of 327 patients who underwent liver transplantation at our center from January 1, 2012 to June 30, 2017. Sixty (18.3%) LTRs had at least one VRE-positive culture between six-months pre-transplant and six-months post-transplant. LTRs with VRE had greater vancomycin exposure as compared to VRE-negative LTRs (p < 0.05) and were more likely to receive prolonged vancomycin courses (> 72 hours, p < 0.05). Overall appropriateness of vancomycin use > 72 hours among VRE-positive LTRs was only 26.8%. Inappropriate vancomycin use most commonly occurred in patients with presumed sepsis without an identifiable source or pneumonia with negative respiratory cultures. Our findings illustrate an opportunity to improve antibiotic stewardship and reduce vancomycin use in the transplant population

scholarly journals Peritoneal Dialysis After Liver Transplantation: A Systematic Review

2021 ◽  
Vol 8 ◽  
pp. 205435812110297
Author(s):  
Jean Maxime Côté ◽  
Isabelle Ethier ◽  
Héloïse Cardinal ◽  
Marie-Noëlle Pépin
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Kidney Failure ◽  
Liver Graft ◽  
Transplant Recipients ◽  
Technique Survival ◽  
Liver Transplant Recipients

Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.

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