Iago Justo

Pyogenic liver abscess (PLA) is a life‐threatening infection in both liver transplant (LT) and non‐LT patients. Several risk factors, such as benign and malignant hepatopancreatobiliary diseases and colorectal tumors have been associated with PLA in the non‐LT population, and hepatic artery stricture/thrombosis, biliary stricture, and hepaticojejunostomy in the LT patients. The objective of this study is to compare the outcomes of patients with PLA in LT and non‐LT patients and to determine the risk factors associated with patient survival. From January 2000 to November 2020, a total of 296 adult patients were diagnosed of PLA in our institution, of whom 26 patients had previously undergone liver transplantation (LTA group), whereas 263 patients corresponded to the non‐LTA population. Seven patients with PLA who had undergone previous kidney transplantation were excluded from this retrospective study. Twenty‐six patients out of 1503 LT developed PLA (incidence of 1.7%). Median age was significantly higher in non‐LTA patients ( p = .001). No significant differences were observed in therapy. PLA recurrence was significantly higher in LTA than in non‐LTA (34.6% vs. 14.8%; p = .008). In‐hospital mortality was greater in the LT group than in the non‐LT group (19.2% vs. 9.1% p = .10) and was identified in multivariable analysis as a risk factor for mortality ( p = .027). Mortality rate during follow‐up did not show significant differences between the groups: 34.6% in LTA patients versus 26.2% in non‐LTA patients ( p = .10). The most common causes of mortality during follow‐up were malignancies, Covid‐19 infection, and neurologic disease. 1‐, 3‐, and 5‐year actuarial patient survival rates were 87.0%, 64.1%, and 50.4%, respectively, in patients of LTA group, and 84.5%, 66.5%, and 51.0%, respectively, in patients with liver abscesses in non‐LTA population ( p = .53). In conclusion, LT was a risk factor for in hospital mortality, but not during long‐term follow‐up.

Introduction Satisfactory outcomes in a series of liver transplantations (LT) with octogenarian liver grafts have been reported, as well as several cases of LT using nonagenarian liver grafts with short follow‐up. Methods From October 2013 to December 2019, we performed 426 LT. Six LTs used nonagenarian livers (case group) and 49 used octogenarian livers (control group). A comparative analysis was performed between groups. Median donor age was significantly higher in the nonagenarian group than in the octogenarian group (90.6 years versus 83.4 years; ( P < .001). There was a significant difference in LT indications ( P = .026) between the groups, but not in perioperative recipient variables, morbidity, or mortality. The 1‐, 3‐, and 5‐year patient survival rates were 67.7% in the recipients of nonagenarian livers and 85.7%, 78.0%, and 74.4%, respectively, in the recipients of octogenarian livers ( P = .631). The 1‐, 3‐, and 5‐year graft survival rates were 66.7% in the recipients of nonagenarian livers and 81.3%, 73.8%, and 70.3%, respectively, in the recipients of octogenarian livers ( P = .745). Conclusions The results of LT with nonagenarian liver grafts are not significantly different from those obtained with octogenarian donors, taking into consideration the small sample size and careful selection of donors and adequate donor‐recipient matching.