Biliary infection after liver transplantation

Aims: Biliary complications after liver transplantation are observed in approximately 20 percent of recipients and cholangitis in addition may complicate biliary leckage or stenosis. In this prospective study, the rate of bacterial and fungal infections in bile samples and their association with clinical parameters was evaluated.

Patients and Methods: A total of 800 ERCs was performed. Of those 217 were performed in 90 patients after LTx. Bile specimen was collected immediately after cannulation of the papilla. Microbiological analysis was performed according to standard procedures. Analysis was classified in sterile, low pathogenic bacteria, enterobacteriae and candida.

Results: In the overall analysis 167 (85%) were not sterile, 29 (14.8%) were sterile, (21 N/A). This was significantly (p<0.05) associated with a previous intervention at the biliary tract, with time-point after LTx and the time-span between the first ERC and the actual examination. Candida was present in 45 (28.3%), absent in 114 (71.7%) of these samples, (58 no information on fungal infection). Candida infection was significantly associated with a previous intervention and with higher serum bilirubin levels. At the last ERC of each patient, 14 (17.2%) were sterile, 67 (82.7%) were not, (N/A 9). Again it was significantly associated with a previous intervention and the time-point of ERC. In this analysis candida was present in 14 (21.2%) and not present in 52 (78.8%) samples (N/A 24). For this analysis candida infection was not significantly associated, but showed a trend towards association with serum bilirubin levels.

Conclusion: The rate of biliary infection was very high in patient undergoing ERC after LTx. The rate was not related to the grade of leukocyte or CRP in either chronic or acute disease, but with a previous intervention at the biliary tract and the time-frame of the ERC. This may help develop strategies to prevent and treat bacterial and fungal infection.