Liver failure in the postoperative patient: the role of sepsis and immunologic deficiency

In a 4 year experience with 7- postoperative or postinjury patients in liver failure, we found that 27 (37 percent) had associated bacterial sepsis. The mortality rate in this group of patients was 48 percent, compared with an average of 80 percent among patients with liver failure from other causes. Laboratory evaluation of cellular immune response in 20 cirrhotic patients confirmed the clinical observation of a relative failure of cellular immunity. Mitogen response of lymphocytes to phytohemagglutinin was significantly decreased in cirrhotic patients as was the number of thymus-derived lymphocytes. The association and poor prognosis of pre-existing liver damage, injury, bacterial sepsis, and liver failure is discussed. It is concluded that a postoperative or postinjury patient, regardless of his general condition, who has any possibility of having undrained intraperitoneal sepsis, deserves re-exploration since the trade-off for benefit usually far outweighs the possibility of doing harm. The decision for reoperation in such critically ill patients is not easy, but such operative aggressiveness is warranted.