Background Bacterial pneumonia in the recipients of liver transplantation （LTX） is a common postoperative complication influencing the prognosis greatly. In this article, the diagnosis and treatment of bacterial pne...Background Bacterial pneumonia in the recipients of liver transplantation （LTX） is a common postoperative complication influencing the prognosis greatly. In this article, the diagnosis and treatment of bacterial pneumonia in 33 LTX recipients are reported.Methods From February 1999 to January 2003, a total of 103 patients underwent allogeneic LTX at our center; afterwards, a retrospective analysis was made on their postoperative clinical manifestations, including symptoms （expectoration, panting and fever）, sign （rale）, results of laboratory examinations （white blood cell count and sputum culture of tracheal secretions or pleural fluid culture） , and chest X-ray films. The following data of the pneumonia and non-pneumonia groups were collected, and the rank sum test （SPSS 11.0, Wilcoxon＇ s method） was used to analyze the duration of postoperative respirator utilization and the volume of pleural effusion through pleurocentesis or pleural drainage. Results In the 103 patients, 33 experienced 53 transplantation, 14 of them （42.42%） had more episodes of bacterial pneumonia during their hospital stay after than three manifestations of the seven mentioned above. The pathogens causing bacterial pneumonia included Pseudomonas aeruginosa （ 17.48% ） , Klebsiella pneumoniae （15.53%）, Acinetobacter baumannii （ 10.68% ）, and Staphylococcus aureus （7.77%）. Amilkacin, tienam, ciprofloxacin, vancomycin, etc. were the antibiotics of choice against those bacteria. Acute rejection occurred during the treatment of bacterial pneumonia in 16 patients, and 5 of them died. Wilcoxon＇ s rank sum test of the data indicated that the pneumonia group had longer duration of postoperative ventilator treatment and larger volume of pleural effusion than the non-pneumonia group （P 〈 0. 05 ）. Conclusions The clinical manifestations of pneumonia after LTX might be atypical, and special attention should be paid to the respiratory symptoms and signs within 2 months after LTX. Whenever the diagnosis of bacterial pneumonia is confirmed, consideration should be given to reasonable use of antibiotics and regulation of immunity in addition to other routine therapies.展开更多
Liver transplantation(LT)is considered one of the best treatments for patients with end-stage liver diseases.However,some patients with no significant clinical manifestations or abnormal laboratory tests still experie...Liver transplantation(LT)is considered one of the best treatments for patients with end-stage liver diseases.However,some patients with no significant clinical manifestations or abnormal laboratory tests still experience graft fibrosis during postoperative follow-up,which is often recognized by graft histopathology.Graft fibrosis can lead to graft dysfunction,thereby reducing the survival time of the recipient and even requiring retransplantation.Currently,noninvasive methods are widely applied in the assessment of hepatic and allograft fibrosis.Although both noninvasive diagnostic models based on laboratory examination indicators and elastography technology that can quantify liver stiffness have some value in the evaluation of fibrosis,the diagnostic accuracy and characteristics of these various methods vary and cannot replace liver biopsy completely.In recent years,some liver-protective drugs and proprietary Chinese traditional medicines have been proven to delay or reverse chronic liver fibrosis.Nevertheless,their efficacy and safety for LT recipients need to be further verified.This article reviews the diagnosis and treatment of graft fibrosis after LT to provide a reference for improving the overall survival rate of LT recipients.展开更多
文摘Background Bacterial pneumonia in the recipients of liver transplantation （LTX） is a common postoperative complication influencing the prognosis greatly. In this article, the diagnosis and treatment of bacterial pneumonia in 33 LTX recipients are reported.Methods From February 1999 to January 2003, a total of 103 patients underwent allogeneic LTX at our center; afterwards, a retrospective analysis was made on their postoperative clinical manifestations, including symptoms （expectoration, panting and fever）, sign （rale）, results of laboratory examinations （white blood cell count and sputum culture of tracheal secretions or pleural fluid culture） , and chest X-ray films. The following data of the pneumonia and non-pneumonia groups were collected, and the rank sum test （SPSS 11.0, Wilcoxon＇ s method） was used to analyze the duration of postoperative respirator utilization and the volume of pleural effusion through pleurocentesis or pleural drainage. Results In the 103 patients, 33 experienced 53 transplantation, 14 of them （42.42%） had more episodes of bacterial pneumonia during their hospital stay after than three manifestations of the seven mentioned above. The pathogens causing bacterial pneumonia included Pseudomonas aeruginosa （ 17.48% ） , Klebsiella pneumoniae （15.53%）, Acinetobacter baumannii （ 10.68% ）, and Staphylococcus aureus （7.77%）. Amilkacin, tienam, ciprofloxacin, vancomycin, etc. were the antibiotics of choice against those bacteria. Acute rejection occurred during the treatment of bacterial pneumonia in 16 patients, and 5 of them died. Wilcoxon＇ s rank sum test of the data indicated that the pneumonia group had longer duration of postoperative ventilator treatment and larger volume of pleural effusion than the non-pneumonia group （P 〈 0. 05 ）. Conclusions The clinical manifestations of pneumonia after LTX might be atypical, and special attention should be paid to the respiratory symptoms and signs within 2 months after LTX. Whenever the diagnosis of bacterial pneumonia is confirmed, consideration should be given to reasonable use of antibiotics and regulation of immunity in addition to other routine therapies.
基金supported by Shandong Province Social Science Popularization and Application Research Project(2021-SKZC-18)。
文摘Liver transplantation(LT)is considered one of the best treatments for patients with end-stage liver diseases.However,some patients with no significant clinical manifestations or abnormal laboratory tests still experience graft fibrosis during postoperative follow-up,which is often recognized by graft histopathology.Graft fibrosis can lead to graft dysfunction,thereby reducing the survival time of the recipient and even requiring retransplantation.Currently,noninvasive methods are widely applied in the assessment of hepatic and allograft fibrosis.Although both noninvasive diagnostic models based on laboratory examination indicators and elastography technology that can quantify liver stiffness have some value in the evaluation of fibrosis,the diagnostic accuracy and characteristics of these various methods vary and cannot replace liver biopsy completely.In recent years,some liver-protective drugs and proprietary Chinese traditional medicines have been proven to delay or reverse chronic liver fibrosis.Nevertheless,their efficacy and safety for LT recipients need to be further verified.This article reviews the diagnosis and treatment of graft fibrosis after LT to provide a reference for improving the overall survival rate of LT recipients.
