Related Experiment Video
Updated: Nov 28, 2025
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Standardization of post-operative antimicrobials reduced exposure while maintaining good outcomes in pediatric liver
Laura L Bio1, Hayden T Schwenk1,2, Sharon F Chen1,2
1Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.
Insights
A new standardized approach significantly reduced antibiotic use after pediatric liver transplants. This strategy lowered exposure to broad-spectrum antibiotics and vancomycin without negatively impacting patient outcomes or increasing infections.
Area of Science:
- Transplantation Medicine
- Infectious Disease Prevention
- Pediatric Surgery
Background:
- Infections post-orthotopic liver transplant (OLT) contribute to significant morbidity and mortality.
- Optimizing antimicrobial prophylaxis is crucial to balance infection prevention with the risks of antibiotic overuse.
- Current guidelines for pediatric OLT antimicrobial prophylaxis are lacking, necessitating standardized protocols.
Purpose of the Study:
- To develop and evaluate a standardized post-operative antimicrobial therapy protocol for pediatric orthotopic liver transplant recipients.
- To reduce overall antimicrobial utilization and associated adverse outcomes.
- To assess the impact of the standardized protocol on clinical outcomes in a large pediatric liver transplant center.
Main Methods:
- A pre-post intervention study design was employed, comparing two cohorts of pediatric OLT recipients.
- The intervention involved a standardized post-operative antimicrobial regimen: 48 hours of antibiotics, restricted vancomycin use for early fever, and selective caspofungin use.
- Data on antimicrobial utilization and clinical outcomes were collected and compared between the pre-intervention and post-intervention groups.
Main Results:
- The standardized protocol significantly reduced the proportion of patients receiving broad-spectrum gram-negative antibiotics for over 48 hours (76% vs 44%, P=.01).
- Post-operative vancomycin use decreased dramatically from 50% in the pre-intervention group to 7.4% in the post-intervention group (P<.001).
- No significant differences were observed in post-operative fever, positive cultures, massive transfusion rates, or hospital length of stay between the groups.
Conclusions:
- Implementation of a standardized post-operative antimicrobial prophylaxis protocol effectively reduced antimicrobial exposure in pediatric OLT recipients.
- The standardized approach achieved significant reductions in broad-spectrum antibiotic and vancomycin use without compromising patient safety or clinical outcomes.
- This strategy offers a viable model for optimizing antimicrobial stewardship in pediatric liver transplantation.
Abstract:
Infections following orthotopic liver transplant (OLT) result in significant morbidity and mortality, warranting careful consideration of risks associated with antibiotic overuse and benefits of infection prevention. In the absence of specific guidelines for antimicrobial prophylaxis in pediatric OLT, we developed a standardized approach to post-operative (post-op) antimicrobial therapy including 48 hours of antibiotics, no vancomycin for post-op fever within the first 48 hours, and caspofungin only for certain situations. The goal was to reduce antimicrobial utilization and adverse outcomes associated with longer duration of and broader treatment while maintaining good outcomes. The impact of this standardization on antimicrobial utilization and clinical outcomes at the largest pediatric liver transplant center in the United States is described. All individuals receiving an OLT from 1/1/17-9/30/17 (N = 38) and 3/14/18-12/13/18 (N = 27) were included in the pre-intervention (PreI) and post-intervention (PostI) groups, respectively. The intervention resulted in a significant reduction in individuals receiving post-op broad-spectrum gram-negative antibiotics for >48 hours (76% PreI vs 44% PostI OLT recipients, P = .01) and post-op vancomycin use (50% PreI, vs 7.4% PostI, P < .001). There were no statistically significant differences between groups for post-op fever, positive pre-/post-operative cultures, receipt of massive transfusion, or hospital length of stay. In conclusion, following the implementation of a standardized approach to post-op prophylaxis, antimicrobial exposure was significantly reduced without affecting OLT recipient outcomes.
More Related Videos
12:40A Modified Murine Heterotopic Heart Transplant Protocol Matching Contemporary Standards of Aseptic Technique, Anesthesia, and Analgesia
Published on: September 28, 2022
12:49Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism