Kamalakannan, R (2012) Unsuspected Bacterial Infection in Deceased Donors and Its Impact on Immediate Post Operative Infections in Liver Recipients. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : For end stage liver disease, liver transplantation is the best treatment. The leading cause of morbidity and mortality in liver transplant patient is infection, especially bacterial infection in early post operative period. Donors are one of the important source for bacterial infection. In past, It was considered systemic bacterial infection in donors as contraindication for organ donation for transmitting infection to immune suppressed recipient. It also affect transplanted liver’s preservability and its function. Transplanted liver is less able to respond to the infective organisms because of recipient’s immunosuppressive state. Their potential risks must be weighed against recipient’s disease severity without transplant . At the same time, in the scenario of increasing demand for organs due to rise in liver diseases, every potential liver graft must be considered for transplant regardless of the infection, to minimize waiting list and mortality. Till now, unstable brain dead patients with severe bacterial and fungal sepsis (culture proved) is a contraindication for organ retrieval. Though some donors look clinically stable, but still they may harbor bacterial infections. In most of the time, donor’s cultures results are available only few days after transplant surgery. There must be every possibility of transmission of donor derived bacterial infection. This consequence of transmission of unsuspected, donor infection to the recipients are not clearly known. Still controversies persists. In recent studies, the infection related complication in recipient due to infected graft are reported as less common and recommend for less restrictive policy of organ duration. But still the evidence are scarce and controversial. AIM : The aim of this study is to analyze the impact of unsuspected donor bacterial infections in recipients. OBJECTIVES : - To determine the incidence of bacterial donor infection. - To analyze duration of ICU stay and donor infections - To analyze donor risk factors for donor infection. - To analyze about recipient infection in immediate post operative period (one week ). - To analyze about type of bacterial infections both in donors and recipients. - To analyze about the main risk factors and its impact on recipient infections. - To analyze the influence of donor infection on graft and patient short-term survival (30-day patient survival). MATERIALS AND METHOD : Deceased donor liver transportation are done in our department since 2008. This is a prospective comparative study to find out risk factors for bacterial infection in donors and donor related recipient infections. The study was conducted from August 2009 to January 2012. The study period is thirty months. Inclusion criteria: The clinically stable donors whose culture status is not known before transplantation. The recipients underwent deceased donor liver transplantation. Exclusion criteria : Cadaver with overt sepsis. Ineligible cadaver for organ donation, due to other medical and ethical reasons. Recipient with pre transplant culture positive status. Recipient who developed infection after one week. Recipient who died in first week after transplantation due to non-infectious cause. CONCLUSION : By analyzing all the factor in donors and recipients, It can be concluded as : Duration of ICU stay , number of inotropes required and its dose are well associated with donor infection. Total WBC count, elevated liver enzymes and renal parameters are important risk indicators for donor infection. Cold ischemia time plays a major role in recipient infection related morbidities by rendering the organs vulnerable to infection. Routine usage of broad spectrum antibiotic followed by appropriate antibiotics prevent effective transmission infection from donor to recipient. The rate of infection transmitted from donor to recipient is neglible. So infection in clinically stable donors are not a contraindication to harvest the organs. But the same time, whenever the donor infection is transmitted to recipient, it produce significant major infection related morbidities. Though the mortality rate was statically insignificant, it increase recipient‟s hospital stay and medical expenditure. Appropriately treated pre transplant donor and recipient infections do not adversely affect outcome including the risk of post transplant infections or mortality after liver transplantation. Over all , by not rejecting the clinically stable but infected donors , expand the donor pool . Many literature supporting the organs donation from donor with sepsis. Most of them are from western studies which is not representing the developing countries. Scenarios in developing countries like India is totally different especially standard of ICU care , medical facilities, surgical experience. This study is from the government institute typically representing the rest of country.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Unsuspected Bacterial Infection ; Deceased Donors ; Immediate Post Operative Infections ; Liver Recipients. |
| Subjects: | MEDICAL > Surgical Gastroenterology and Proctology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 28 Jul 2017 02:54 |
| Last Modified: | 28 Jul 2017 02:54 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2253 |
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