Bob, think what you heard was related to Microcide's press release made yesterday. Will look for it and post it here.
BTW something to save for data on occurrence, not treatment, of sepsis in liver transplants.
Bacterial and fungal sepsis-related deaths after liver transplantation
M. Ahmed, MD, D. Mirza, FRCS, D. Mayer, FRCS, J. Buckels, FRCS, P. McMaster, FRCS and J.
Pirenne, MD, Liver Unit, Birmingham, UK and UZ Gasthuisberg, Leuven, Belgium.
Results of liver transplantation (LTx) have dramatically improved over the last decade, but sepsis remains a major cause
of mortality. We searched to identify demographics, incidence, timing, and risk factors for deaths directly related to either
bacterial sepsis or fungal sepsis after LTx.
Methods: Prospectively collected data of consecutive adult (>16 yo) LTx done between 1982-1996 were reviewed.
Deaths due to sepsis were analyzed. Septic deaths secondary to Hepatic Artery Thrombosis (HAT), Multiple Organ
Failure (MOF), and Primary Non Function (PNF) were not included. Mann-Whitney, Kruskal-Wallis, and Fisher exact
tests were used -p< 0.05 was considered as significant (S).
Results: 898 adults were transplanted during the study period and the 1, 5, and 10 year patient survival was 77%, 70%,
and 63%, respectively. 256 patients (28.5%) died during follow-up (up to 14 years). Mortality due to primary bacterial
sepsis and fungal sepsis was 8.5% and 7.8%, respectively. Other causes of deaths included MOF (19.5%), HAT
(3.5%), PNF (2.3%), chronic rejection (2%), tumor recurrence (11%), and miscellaneous: hemorrhage, cardiac, disease
recurrence, accident etc...(45.4%). Median time to death was 59.5 days (1-1789) after bacterial sepsis and 42.5 days
(9-802) after fungal sepsis.
Deaths due to: Bacterial Sepsis; n=22 Fungal Sepsis; n=20 Control; n=642
Age
52.5
47.8
49
Days on ventilation
2
4*
1
Poor nutritional status
3/22 (13.6%)
4/20 (20%)*
51/642 (8%)
Retransplant
6/22 (27%)*
6/20 (30%)*
44/642 (6.8%)
Fulminant liver failure
4/22 (18%)
6/20 (30%)*
84/642 (13%)
Blood transfusion-units
8.5 (0-54)*
14 (1-62)*
5 (0-58)
Day3 creatinine (um/L)
218 (64-737)*
174 (72-550)*
101 (45-536)
*significant, compared with survivors. **p=0.07
Conclusions: 1) Primary bacterial and fungal sepsis (unrelated to HAT, MOF, and PNF) represent an important cause
of death after LTx (16.3%); 2) Risk factors for both bacterial and fungal sepsis include reTx, intraoperative blood
transfusion, and postTx renal dysfunction; and 3) Deaths to fungal sepsis were also associated with poor nutritional
status preTx, Tx for fulminant liver failure, and prolonged ventilatory support postTx. To decrease sepsis-related
mortality after LTx, more aggressive anti-bacterial and anti-fungal prophylaxis should be adopted in these high-risk
recipient categories.
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