Randomized control trial on perioperative antibiotic prophylaxis in live liver donors: Are three doses enough?

Published on Oct 20, 2021in Journal of Hepato-biliary-pancreatic Sciences7.027
· DOI :10.1002/JHBP.1053
Sahil Gupta7
Estimated H-index: 7
,
Piyush Kumar Sinha7
Estimated H-index: 7
+ 5 AuthorsViniyendra Pamecha16
Estimated H-index: 16
Sources
Abstract
INTRODUCTION The duration of perioperative antibiotic prophylaxis following live liver donor hepatectomy (LDH) is not known. METHODS This is a double-blind equivalence trial. All consecutive LDH were randomized into: group A (three doses) and group B (nine doses) of perioperative antibiotics (piperacillin + tazobactam - 4.5 g intravenous) at fixed 8 hourly intervals. Primary end point was incidence of infective complications as per CDC (Centers for Disease Control and Prevention) criteria. Secondary end points were liver function tests, total leukocyte count, international normalized ratio, hospital stay, morbidity, and cost analysis. RESULTS One hundred and twenty-six LDHs were enrolled. A total of 19.8% (n = 25) experienced postoperative complications, 11 (17.7%) in group A and 14 (21.9%) in group B (P = .561). Infective complications were seen in 11 donors (8.1%), five in group A and six in group B (P = .79). A total of 8.1% of donors required continuation/up-gradation of antibiotics in group A and 9.4% in group B. Return to soft diet was delayed in group B (P = .039). Median hospital stay and cost were similar. CONCLUSION Three doses of perioperative antibiotic are equally effective in preventing infective complications.
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References26
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#1Viniyendra PamechaH-Index: 16
#2Ankur VagadiyaH-Index: 1
Last. Shiv Kumar SarinH-Index: 97
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: In countries where deceased organ donation is sparse, emergency living donor liver transplantation (LDLT) is the only lifesaving option in select patients with acute liver failure (ALF). The aim of the current study is living liver donor safety and recipient outcomes following LDLT for ALF. A total of 410 patients underwent LDLT between March 2011 and February 2018, out of which 61 (14.9%) were for ALF. All satisfied the King's College criteria (KCC). Median admission to transplant time was 48...
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#1Hiroji Shinkawa (OCU: Osaka City University)H-Index: 15
#2Shogo Tanaka (OCU: Osaka City University)H-Index: 23
Last. Shoji Kubo (OCU: Osaka City University)H-Index: 59
view all 10 authors...
Aim: The 2016 guidelines of the Japan Society for Surgical Infection and the Japan Society of Chemotherapy advocate giving prophylactic antibiotics 1 hour before surgery and until 24 hours after surgery in patients undergoing elective hepatic resection. However, the efficacy of short-term antimicrobial prophylaxis has not been evaluated according to surgical approach. We evaluated the efficacy of giving prophylactic antibiotics in patients undergoing open or laparoscopic hepatic resection. Metho...
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#1Danielle Berglund (Fairview Health Services)H-Index: 10
#2Varvara Kirchner (UMN: University of Minnesota)H-Index: 13
Last. Srinath Chinnakotla (UMN: University of Minnesota)H-Index: 33
view all 10 authors...
Background Living liver donation is one of the most selfless and humane acts a person can perform. Few single-center reports have been published specifically evaluating complications and quality of life post-donation. Study Design We conducted a retrospective analysis of outcomes of 176 living liver donors at our center to determine the incidence, type, and Clavien grade of complications, as well as long-term quality of life. Results Of 176 living donors, 154 underwent right hepatectomy, 4 under...
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#1Gen Sugawara (Nagoya University)H-Index: 27
#2Yukihiro Yokoyama (Nagoya University)H-Index: 54
Last. Masato Nagino (Nagoya University)H-Index: 93
view all 7 authors...
Objective:To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing “complicated”’ major hepatectomy with extrahepatic bile duct resection.Background:To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. H
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Background Selection of appropriate donors after rigorous evaluation is of paramount importance in living-donor liver transplantation. Despite this, donor surgery may not proceed due to unforeseen reasons. The aim of this paper is to study reasons for “no go” donor hepatectomy in living liver donors.
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#1Jae Geun Lee (Yonsei University)H-Index: 9
#2Kwang-Woong Lee (SNU: Seoul National University)H-Index: 30
Last. Myoung Soo KimH-Index: 28
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Major concerns about donor safety cause controversy and limit the use of living donor liver transplantation to overcome organ shortages. The Korean Organ Transplantation Registry established a nationwide organ transplantation registration system in 2014. We reviewed the prospectively collected data of all 832 living liver donors who underwent procedures between April 2014 and December 2015. We allocated the donors to a left lobe group (n = 59) and a right lobe group (n = 773) and analyzed the re...
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#1Sandra I. Berríos-Torres (CDC: Centers for Disease Control and Prevention)H-Index: 12
#2Craig A. Umscheid (UPenn: University of Pennsylvania)H-Index: 42
Last. William P. Schecter (UCSF: University of California, San Francisco)H-Index: 33
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Importance The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. Objective To provide new and updated evidence-based recommendations for the prevention of SSI. Evidence Review A targeted systema...
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#1Fabian RösslerH-Index: 2
#2Gonzalo Sapisochin (U of T: University of Toronto)H-Index: 24
Last. Andrea Gatti (UGent: Ghent University)H-Index: 2
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Objective:To measure and define the best achievable outcome after major hepatectomy.Background:No reference values are available on outcomes after major hepatectomies. Analysis in living liver donors, with safety as the highest priority, offers the opportunity to define outcome benchmarks as the bes
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#1Yanming Zhou (Ha Tai: Xiamen University)H-Index: 21
#2Zhen-Yi Chen (Ha Tai: Xiamen University)H-Index: 1
Last. Bin Li (Ha Tai: Xiamen University)H-Index: 21
view all 6 authors...
Background and Aim Postoperative infection is not uncommon after hepatectomy. This study assessed the effectiveness of preoperative antibiotic prophylaxis in elective hepatectomy in a randomized clinical trial setting.
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Biliary complications after donor hepatectomy can result in significant morbidity. We herein present our experience of donor hepatectomy, highlighting surgical techniques that prevent complications. Data were reviewed from a prospectively maintained database of all donors who underwent hepatectomy from April 2011 to April 2015. Standard operative technique as described was followed in all patients. Biliary complications and morbidity were recorded and stratified as per Clavien-Dindo classificati...
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