Traslocación de ADN Bacteriano en los primeros 100 pacientes trasplantados hepáticos en el Hospital General Universitario de Alicante
- Alcazar Lopez, Candido Fernando
- Félix Lluís Director
- Rubén José Francés Guarinos Director
- Pablo Ramírez Romero Director
Defence university: Universidad de Murcia
Fecha de defensa: 27 November 2020
- Ramón Charco Chair
- José Antonio Pons Miñano Secretary
- José Manuel Ramia Ángel Committee member
Type: Thesis
Abstract
Bacterial translocation (BT) --the passage of bacteria from the intestinal lumen to the mesenteric lymph nodes or other extraintestinal organs-- is a major cause of morbidity and mortality in cirrhotic patients. Liver transplantation is a very decisive procedure that involves a profound alteration of the balance between the microbiota and the host. The evolution of BT after liver transplantation is unknown. The aims of the present study were: a) to compare the percentage of cirrhotic patients with BT before and after receiving a liver transplant; b) estimate the rate of liver donors presenting BT; and c) explore whether there is a relationship between BT and post-liver transplant complications. Patients and Method: Peripheral blood samples were obtained from donors before liver extraction. Peripheral blood was obtained from recipients before and at 3, 15, and 30 days after transplantation; portal blood was obtained from recipients during transplantation. The presence of bacterial DNA of intestinal origin, endotoxin, and the level of the pro-inflammatory cytokines TNF-α and IL-6 was determined. All complications during the first post-transplant year were recorded according to the Clavien-Dindo classification. Logistic regression analysis was used to identify possible predictors of: 1) the presence of bacterial DNA before and one month after transplantation, and 2) the appearance of clinical complications during the first year after transplantation. Results: The study was limited to the first 100 consecutive liver transplant patients, between 2012-2015, at the General University Hospital of Alicante. Age (mean ± SD) was 57.4 ± 8.1 years, and alcoholic etiology was the most frequent. The MELD score was 16.4 ± 6. Bacterial DNA was detected in the peripheral blood of 23 recipients before transplantation, and in 34 recipients during the first month after transplantation. Only 8 donors had bacterial DNA in peripheral blood. There were no differences in any of the variables examined in patients with or without bacterial DNA, except that a greater proportion of the latter underwent intestinal decontamination before transplantation (32% vs 8%, p = 0.017). The peripheral blood level of endotoxin (1.19 ± 0.32 pg/mL), TNF-α (73.26 ± 33.35 pg/mL) and IL-6 (82.44 ± 39.20 pg/mL) of recipients with bacterial DNA was significantly higher than in recipients without bacterial DNA (0.50 ± 0.28 pg/mL), (20.23 ± 20.94 pg/mL) and (23.55 ± 23 , 31 pg/mL), (p = 0.0001, p = 0.009, and p = 0.008), respectively. The level of TNF-α before transplantation was the only independent predictive factor for the presence of bacterial DNA in the first month after transplantation (p = 0.015). No relationship was found between the presence of bacterial DNA during the first month and the appearance of complications in the first year after transplantation, including acute rejection. However, patients who presented bacterial DNA during the first month were readmitted more during the first year after transplantation (p = 0.0001). Conclusions: Liver transplant patients show an inflammatory profile similar to cirrhotic patients. This pro-inflammatory state does not translate into an increase in complications in the immediate postoperative period (30 days) or during the first year after transplantation. Translocation of bacterial DNA fragments does not increase bacterial infectious complications, rejection, or mortality in recipients of a liver graft. Transplant patients with circulating bacterial DNA have a higher rate of hospital readmissions during the first year.