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Extremity risk factors of sepsis for the pre-transplant evaluation of gastrointestinal endoscopy on waiting list of living donor liver transplantation (Preprint)


 BACKGROUND
 Surveys for extrahepatic malignancy are recommended before transplantation. Upper and lower gastrointestinal (GI) endoscopy is performed to exclude malignancy in cirrhotic patients before living donor liver transplantation (LDLT) in our center. However, sepsis occurs in some patients after elective endoscopy.
 
 
 OBJECTIVE
 We reported the incidence and risk factors for sepsis associated with GI endoscopy.
 
 
 METHODS
 This retrospective study reviewed the medical records of 642 adult recipients who underwent endoscopy from 2008 to 2016. We analyzed the incidence and risk factors of post-endoscopy sepsis during 2008-2012 (experience cohort). Our protocol changed after 2013 (validation cohort) to include prophylactic antibiotics for every LDLT candidate.
 
 
 RESULTS
 During 2008-2012 (experience cohort), 10.5% (36 cases) of the 342 LDLT candidates experienced sepsis within 48 hours after elective GI endoscopy. The sepsis rate was significantly higher in decompensated cirrhotic patients than in patients with Child-Pugh class A (22.2% vs. 9.6% vs. 2.6% in Child C/B/A groups respectively; x2= 20.97, P <.001). According to a multivariate logistic regression analysis, the factors related to post-endoscopy sepsis were the Child-Pugh score (OR 1.46; 95% CI 1.24-1.71), Child-Pugh classes B and C (OR 3.80 and 14.13; 95% CI 1.04-13.95 and 3.97-50.23, respectively), hepatic hydrothorax (OR 4.85; 95% CI 1.37-17.20), and antibiotic prophylaxis (OR 0.08; 95% CI 0.01-0.64). After 2013 (validation cohort), antibiotics were given routinely, and all cases of hepatic hydrothorax (n=10) were drained if present prior to endoscopy. As a result, 4 (1.3%) episodes of sepsis occurred among 300 LDLT candidates, and the incidence was significantly lower than before (1.3% vs. 10.5%, P <.001).
 
 
 CONCLUSIONS
 Patients with decompensated cirrhosis and hepatic hydrothorax have higher risk of sepsis related to GI endoscopy. In cases of elective GI endoscopy, antibiotic prophylaxis and drainage of hepatic hydrothorax may be required to prevent sepsis in advanced cirrhotic patients.
 
 
 CLINICALTRIAL
 this is a retrospective study, approved by our hospital IRB(no. 201800328B0)
