Bacterial translocation after cirrhotic liver resection: a clinical investigation of 181 patients
Dah-Cherng Yeh1, Cheng-Chung Wu, Wai-Meng Ho
1Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Background:
Cirrhotic patients are usually associated with a high susceptibility to infection. Although bacterial translocation from gut mucosa to mesenteric lymph node (MLN) and systemic circulation is a well-known phenomenon after hepatectomy, its role in cirrhotic patients remains unclear.
Materials And Methods:
MLN was harvested for bacterial culture before and after liver resection in 181 cirrhotic patients. The characteristics and postoperative courses of patients with positive and negative bacterial culture for MLN after hepatectomy were compared. Postoperative systemic antibiotics were administered if infectious complications occurred.
Results:
No bacteria were cultured in MLN before hepatectomy. Bacterial translocation (BT) to MLN after hepatectomy occurred in 36 patients (BT group). After multivariate analysis, intraoperative blood transfusion was the only independent factor that influenced bacterial translocation rates after cirrhotic liver resection. BT group patients also had higher infectious and overall complication rates, with a longer postoperative hospital stay. Among the cultured bacteriae from infected sites in BT group patients with infectious complications, only 2 patients (12.5%) had totally different bacterial species to those cultured from MLNs.
Conclusions:
Bacterial translocation more often occurred after liver resection in cirrhotic patients who received intraoperative blood transfusion. Such patients had higher postoperative infectious and overall complication rates. Thus, avoidance of intraoperative blood transfusion is mandatory for cirrhotic liver resection.
Insights
Bacterial translocation (BT) after liver resection is common in cirrhotic patients, particularly after blood transfusions. This increases infection risk and complications, highlighting the need to avoid transfusions during surgery.
Area of Science:
- Hepatology
- Surgical Oncology
- Infectious Diseases
Background:
- Cirrhotic patients exhibit increased susceptibility to infections.
- Bacterial translocation (BT) post-hepatectomy is known, but its role in cirrhosis is unclear.
Purpose of the Study:
- To investigate the incidence and impact of bacterial translocation in cirrhotic patients undergoing liver resection.
- To identify factors influencing BT and its association with postoperative outcomes.
Main Methods:
- Mesenteric lymph nodes (MLN) were cultured before and after liver resection in 181 cirrhotic patients.
- Characteristics and outcomes of patients with positive vs. negative MLN cultures were compared.
- Intraoperative blood transfusion and postoperative complications were analyzed.
Main Results:
- No pre-hepatectomy MLN bacterial growth was observed.
- Bacterial translocation to MLN occurred in 36 patients post-hepatectomy.
- Intraoperative blood transfusion was the sole independent factor predicting BT; BT patients had higher complication rates and longer hospital stays.
Conclusions:
- Bacterial translocation is more frequent after liver resection in cirrhotic patients receiving intraoperative blood transfusions.
- These patients experience increased postoperative infectious and overall complication rates.
- Avoiding intraoperative blood transfusions is crucial for cirrhotic liver resection to minimize complications.
