Orthotopic liver transplantation: An experimental study on the prevention of infections with Gram-negative organisms

Abstract

Abstract Infection with Gram-negative bacteria is frequently the cause of death in human liver transplantation. In experimental liver transplantation in mongrel dogs we detected Gram-negative septicaemia in 73 per cent of our first 15 cases; maximal survival was 26 days. In a second series of 27 orthotopic liver transplantations in tissue-typed littermate dogs and littermate pigs the standard surgical technique and aftercare were changed with regard to four factors: an end-to-end common bile duct anastomosis was made instead of a gallbladder to duodenum anastomosis; the continuous postoperative bacteriostatic antibiotic therapy was changed to a single 2-day course of bactericidal antibiotics; preoperative selective bowel decontamination combined with postoperative protective isolation was introduced; the dosage of azathioprine used for immuno-suppression was reduced. Infectious complications decreased markedly to 8 per cent, with survival beyond 1 year in 37 per cent of the animals. Therefore under experimental conditions Gram-negative septicaemia can be prevented in liver transplantation; whether all the factors cited above are important in this regard remains to be determined.