Hepatic gas gangrene following orthotopic liver transplantation: Three cases treated with re-transplantation and a review of the literature

Susanne Doblecki-Lewis, E. Palaios, P. A. Bejarano, A. G. Tzakis, Gennaro Selvaggi, Michele I Morris

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Gas gangrene is a rare and devastating infectious process that can occur after liver transplantation, most often following hepatic artery thrombosis. We here report 3 cases of gas gangrene following orthotopic liver transplantation. Blood cultures were positive for Clostridium clostridiiforme in one case. In 2 other cases liver tissue from explanted specimens was positive for Enterobacter cloacae. Ultrasound demonstrated hepatic artery thrombosis and computed tomography imaging revealed diffuse liver necrosis with gas formation in each case. All 3 patients were successfully treated with a combination of antibiotics and emergent re-transplantation. We review previously published cases of gas gangrene after liver transplant and emphasize the importance of hepatic artery thrombosis in the development of this syndrome as well as the frequent involvement of non-clostridial organisms. Early diagnosis and aggressive combined medical and surgical treatment including re-transplantation are essential for successful treatment of these rare and catastrophic infections.

Original languageEnglish
Pages (from-to)280-285
Number of pages6
JournalTransplant Infectious Disease
Volume10
Issue number4
DOIs
StatePublished - Aug 1 2008

Fingerprint

Gas Gangrene
Hepatic Artery
Liver Transplantation
Thrombosis
Transplantation
Liver
Enterobacter cloacae
Clostridium
Early Diagnosis
Necrosis
Gases
Tomography
Anti-Bacterial Agents
Transplants
Therapeutics
Infection

Keywords

  • Gas gangrene
  • Hepatic artery thrombosis
  • Liver transplantation
  • Re-transplantation

ASJC Scopus subject areas

  • Transplantation
  • Microbiology (medical)
  • Immunology

Cite this

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title = "Hepatic gas gangrene following orthotopic liver transplantation: Three cases treated with re-transplantation and a review of the literature",
abstract = "Gas gangrene is a rare and devastating infectious process that can occur after liver transplantation, most often following hepatic artery thrombosis. We here report 3 cases of gas gangrene following orthotopic liver transplantation. Blood cultures were positive for Clostridium clostridiiforme in one case. In 2 other cases liver tissue from explanted specimens was positive for Enterobacter cloacae. Ultrasound demonstrated hepatic artery thrombosis and computed tomography imaging revealed diffuse liver necrosis with gas formation in each case. All 3 patients were successfully treated with a combination of antibiotics and emergent re-transplantation. We review previously published cases of gas gangrene after liver transplant and emphasize the importance of hepatic artery thrombosis in the development of this syndrome as well as the frequent involvement of non-clostridial organisms. Early diagnosis and aggressive combined medical and surgical treatment including re-transplantation are essential for successful treatment of these rare and catastrophic infections.",
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AU - Palaios, E.

AU - Bejarano, P. A.

AU - Tzakis, A. G.

AU - Selvaggi, Gennaro

AU - Morris, Michele I

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AB - Gas gangrene is a rare and devastating infectious process that can occur after liver transplantation, most often following hepatic artery thrombosis. We here report 3 cases of gas gangrene following orthotopic liver transplantation. Blood cultures were positive for Clostridium clostridiiforme in one case. In 2 other cases liver tissue from explanted specimens was positive for Enterobacter cloacae. Ultrasound demonstrated hepatic artery thrombosis and computed tomography imaging revealed diffuse liver necrosis with gas formation in each case. All 3 patients were successfully treated with a combination of antibiotics and emergent re-transplantation. We review previously published cases of gas gangrene after liver transplant and emphasize the importance of hepatic artery thrombosis in the development of this syndrome as well as the frequent involvement of non-clostridial organisms. Early diagnosis and aggressive combined medical and surgical treatment including re-transplantation are essential for successful treatment of these rare and catastrophic infections.

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