Elsevier

Transplantation Proceedings

Volume 44, Issue 7, September 2012, Pages 1966-1972
Transplantation Proceedings

Liver transplantation
Complication: Infection
Safety of Polymyxin-B–based Hemoperfusion in Kidney and Liver Transplant Recipients

https://doi.org/10.1016/j.transproceed.2012.05.057Get rights and content

Abstract

Infection represents one of the primary barriers to successful organ transplantation. Our principal end point was to use a new assay, Entotoxin Activity Assay (EAA), which was developed to rapidly detect endotoxin activity (EA) for an early diagnosis of this complication. We also sought to prove the validity and safety of endotoxin removal using polymyxin-B–based hemoperfusion (PMX-DHP). The criterion for inclusion in the study was suspected infection when a patient experienced at least 2 of the 4 criteria of the systemic inflammatory response syndrome. EAA was performed on 71 patients: 29 liver transplantations and 42 kidney transplantations. Twenty-eight patients (39.5%) with EA >0.60 underwent PMX-DHP treatment to remove endotoxins. Each treatment was performed for 2 hours with a blood flow of 100 mL/min. All of the patients were treated with PMX-DHP until achieving an EA <0.4. Stabilization of hemodynamic and inflammatory frameworks was observed after the PMX-DHP. At 30 days follow-up, all of the patients were alive with good graft function and low levels of EA. We think it might be useful to determine EA routinely in transplant patients and look forward to large multicenter clinical trials to accurately assess the benefits of the EAA plus DHP-PMX to treat transplant patients with sepsis.

Section snippets

Methods

We studied all 191 adults with available follow-up data who underwent primary transplantation with a graft from a cadaveric donor from April 2008 to January 2011: 60 nonurgent liver and 131 kidney transplantations. Retransplantations and combined liver/kidney recipients were excluded. The criteria for inclusion were infection suspected by the presence of at least 2 of the 4 criteria of systemic inflammatory response syndrome (SIRS), ie, fever or hypothermia (temperature >38°C or <36°C,

Results

Fourteen liver (48.2%) and 14 kidney (38.7%) transplant patients showed positive EA levels and were treated with PMX-DHP: 11 liver transplant patients within 15 days and 3 within 48 days after transplantation and 6 kidney transplant patients within 30 and 8 within 74 days. There was no significant correlation between EA and immunosuppressive regimes. Before performing PMX-DHP treatments, the median EAs were 0.81 (range, 0.62–1.25) and 0.73 (range, 0.61–0.98) for liver and kidney transplant

Discussion

Today, the prevention of infection has become a major goal of transplantation. In a retrospective observational study on 3,000 adult patients with suspected infection, Shapiro et al20 reported the best outcomes (mortality 1.3%, odds ratio (OR) 0.8) among patients with SIRS compared with those with severe sepsis (mortality 9.2%, OR 4.0). Early recognition of EA may be the key to determine timing and results of treatment. EAA can help us to determine (after just 40 minutes), the presence of EA in

Note

Some data of this article were previously published in the following report: Novelli G, Ferretti G, Poli L, et al: Clinical results of treatment of postsurgical endotoxin-mediated sepsis with polymyxin-B direct hemoperfusion. Transplant Proc 42:1021, 2010. Fig 2.

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