High incidence of periodontitis in patients with ascitic decompensated cirrhosis

BACKGROUND Periodontitis has been associated with various liver diseases.However,the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive.In particular,it is unclear whether the common periodontitis pathogens,Porphyromonas gingivalis(P.gingivalis)and Actinobacillus actinomycetemcomitans(A.actinomycetemcomitans),can be detected not only in the oral mucosa but also in ascites and stool.AIM To investigate the significance of periodontitis,P.gingivalis,and A.actinomycetemcomitans in cirrhosis patients with ascitic decompensation.METHODS This prospective study was conducted at the University Hospital Hamburg Eppendorf,a tertiary center in Northern Germany.A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis,as well as patient outcomes.PCR was used to test gingival samples,ascites,and stool for the presence of P.gingivalis and A.actinomycetemcomitans.Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab.RESULTS Periodontitis was diagnosed in 22 out of 27(82%)ascite patients,which is significantly more common than in a control cohort of 100 unselected patients(59%,P=0.04).P.gingivalis was detected in the gingiva of six patients,and one of them also had P.gingivalis in their stool.However,P.gingivalis was not found in the ascites of any patient.Five out of six patients with P.gingivalis had periodontitis(83%).A.actinomycetemcomitans was not detected in any sample.Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis,and survival(Kaplan-Meier analysis)was longer in patients with periodontitis(P=0.02).Transplantfree survival was also more common in patients with periodontitis compared to those without(63%vs 0%,P=0.02).CONCLUSION Decompensated cirrhotic patients frequently suffer from periodontitis.However,there was no evidence of the translocation of P.gingivalis or A.actinomycetemcomitans into ascites.The survival of cirrhotic patients with periodontitis was not reduced.

Factors associated with long-term survival after liver transplantation:A retrospective cohort study

AIM To identify predictive factors associated with long-term patient and graft survival(> 15 years) in liver transplant recipients.METHODS Medical charts of all de novo adult liver transplant recipients(n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed.In total,155 transplantations were identified in this time period(15 re-transplantations).Twenty-six orthotopic liver transplant(OLT) recipients were early lost to followup due to moving to other places within 1 year after transplantation.All remaining 114 patients were included in the analysis.The following recipient factors were analysed:Age,sex,underlying liver disease,pre-OLT body mass index(BMI),and levels of alanine aminotransferase(ALT),bilirubin,creatinine and gammaglutamyltransferase(gamma-GT),as well as warm and cold ischemia times.Furthermore,the following donor factors were assessed:Age,BMI,cold ischemia time and warm ischemia time.All surviving patients were followed until December 2014.We divided patients into groups according to their underlying diagnosis:(1) hepatocellularcarcinoma(n = 5,4%);(2) alcohol toxic liver disease(n = 25,22.0%);(3) primary sclerosing cholangitis(n = 6,5%);(4) autoimmune liver diseases(n = 7,6%);(5) hepatitis C virus cirrhosis(n = 15,13%);(6) hepatitis B virus cirrhosis(n = 21,19%);and(7) other(n = 35,31%).The group "other" included rare diagnoses,such as acute liver failure,unknown liver failure,stenosis and thrombosis of the arteria hepatica,polycystic liver disease,Morbus Osler and Caroli disease.RESULTS The majority of patients were male(n = 70,61%).Age and BMI at the time point of transplantation ranged from 16 years to 69 years(median:53 years) and from 15 kg/m^2 to 33 kg/m^2(median:24),respectively.Sixty-six OLT recipients(58%) experienced a follow-up of 15 years after transplantation.Recipient's age(P = 0.009) and BMI(P = 0.029) were identified as risk factors for death by χ~2-test.Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival(P = 0.008 and P = 0.020).Hepatitis B as underlying disease showed a trend for improved long-term survival(P = 0.049,χ~2-test,P = 0.055;Kaplan-Meier analysis,Log rank).Pre-transplant bilirubin,creatinine,ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.CONCLUSION The recipients' age and BMI were predictors of longterm survival after OLT,as well as hepatitis B as underlying disease.In contrast,donors' age and BMI were not associated with decreased survival.These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.

The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications,preoperative chemotherapy,and surgical procedures

Background:Bile leaks are one of the most common complications after liver resection.The International Study Group of Liver Surgery(ISGLS)established a uniform bile leak definition including a severity grading.However,a risk factor assessment according to ISGLS grading as well as the clinical implications has not been studied sufficiently so far.Methods:The incidence and grading of bile leaks according to ISGLS were prospectively documented in 501 consecutive liver resections between July 2012 and December 2016.A multivariate regression analysis was performed for risk factor assessment.Association with other surgical complications,90-day mortality as well as length of hospital stay(LOS)was studied.Results:The total rate of bile leaks in this cohort was 14.0%:2.8%grade A,8.0%grade B,and 3.2%grade C bile leaks were observed.Preoperative chemotherapy or biliary intervention,diagnosis of hilar cholangiocarcinoma,colorectal metastasis,central minor liver resection,major hepatectomy,extended hepatectomy or two-stage hepatectomy,were some of the risk factors leading to bile leaks.The multivariate regression analysis revealed that preoperative chemotherapy,major hepatectomy and biliodigestive reconstruction remained significant independent risk factors for bile leaks.Grade C bile leaks were associated not only with surgical site infection,but also with an increased 90-day mortality and prolonged LOS.Conclusions:The preoperative treatment as well as the surgical procedure had significant influence on the incidence and the severity of bile leaks.Grade C bile leaks were clinically most relevant,and led to significant increased LOS,rate of infection,and mortality.