The aim of this study is to evaluate the incidence and type of various infectious problems in early postoperative period in Living Donor Liver Transplantation (LDLT) among Egyptian patients. A retrospective study of the first 25 patients submitted to living donor liver transplantation (LDLT) in a private centre in Egypt ( Dar Al Fouad Hospital) during 16 month duration between August 2001 till January 2003.All had liver cell failure mostly due to viral hepatitis (C and/or B) Preoperative and early postoperative follow up for one month were done in the form of clinical examination. Lab workup, imaging and cultures when there is clinically suspected infections.
23 were males 2 females age ranging from 5-63yrs ,mean 48.08+/- 11.2 , 22 cases were post HCV infections 1 post HBV 1 congenital biliary atrisia and one patients were cryptogenic cirrhosis The incidence of early postoperative infection (first month) was mainly pure bacterial infection (60%) and in the minority being mixed with fungal and viral infection (20%). The most common type of bacteria was Gram +ve Staphylcoccus infection either Staph. aureus (28%) or coagulase negative Staph.(36%) followed by Gram -ve bacilli mainly Pseudomonas represent 32%.The main site of bacterial infection was biliary drain and abdominal surgivac. Early postoperative infection was related to the preoperative occurrence of:Diabetes mellitus in 36% of cases SBP in 28% of cases and postoperatively by: Immunosuppressant drug level. Presence of vascular problem either hepatic artery in 42.9% or portal vein in 33.3% Biliary obstruction (stricture) in 38% chest effusion in 76.2% Abdominal collection in 57%. High incidence of bacterial infections (80% of cases) in early postoperative period mainly Gram positive and the mainly from biliary drains. Preoperative DM and SBP were risk factors. Postoperative pleural effusion biliary obstruction (stricture) and high immunosuppressive level are also considered as important risk factors Graft Recipient Body Weight (GRBW) and prolonged ICU and total hospital stay were related to the incidence of early postoperative infection.
Regular and strict follows up of the infection control procedures all through the steps of early LDLT operation. Shortening of the hospital stay as much as possible. Control of curable preoperative risk factors. Proper choice of prophylactic antimicrobial .Proper adjustment of the dose of immunosuppressive drugs Proper graft size will not only improve the overall patient survival but also help in the reduction of early post operative infection.