Bacterial DNA translocation contributes to systemic inflammation and to minor changes in the clinical outcome of liver transplantation.
Por:
Rodríguez-Laiz GP, Zapater P, Melgar P, Alcázar C, Franco M, Giménez P, Pascual S, Bellot P, Palazón JM, Rodríguez M, Carnicer F, Más-Serrano P, González-Navajas JM, Gómez L, Such J, Lluís F, Francés R and Liver Transplantation Group
Publicada:
29 ene 2019
Ahead of Print:
29 ene 2019
Resumen:
Bacterial (bact)DNA is an immunogenic product that frequently translocates into the blood in cirrhosis. We evaluated bactDNA clearance in patients undergoing liver transplantation (LT) and its association with inflammation and clinically relevant complications. We prospectively included patients consecutively admitted for LT in a one-year follow-up study. We evaluated bactDNA before and during the first month after LT, quantifying cytokine response at 30 days. One hundred patients were included. BactDNA was present in the blood of twenty-six patients undergoing LT. Twenty-four of these showed bactDNA in the portal vein, matching peripheral blood-identified bactDNA in 18 cases. Thirty-four patients showed bactDNA in blood during the first month after LT. Median TNF-a and IL-6 levels one month after LT were significantly increased in patients with versus without bactDNA. Serum TNF-a at baseline was an independent risk factor for bactDNA translocation during the first month after LT in the multivariate analysis (Odds ratio (OR) 1.14 [1.04 to 1.29], P = 0.015). One-year readmission was independently associated with the presence of bactDNA during the first month after LT (Hazard ratio (HR) 2.75 [1.39 to 5.45], P = 0.004). The presence of bactDNA in the blood of LT recipients was not shown to have any impact on complications such as death, graft rejection, bacterial or CMV infections. The rate of bactDNA translocation persists during the first month after LT and contributes to sustained inflammation. This is associated with an increased rate of readmissions in the one-year clinical outcome after LT.
Filiaciones:
Rodríguez-Laiz GP:
Servicio de Cirugía General y del Aparato Digestivo, HGUA, Alicante, Spain
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Servicio de Farmacología Clínica, Hospital General Universitario, Alicante, Spain
CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
Melgar P:
Servicio de Cirugía General y del Aparato Digestivo, HGUA, Alicante, Spain
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Alcázar C:
Servicio de Cirugía General y del Aparato Digestivo, HGUA, Alicante, Spain
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Franco M:
Servicio de Cirugía General y del Aparato Digestivo, HGUA, Alicante, Spain
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Giménez P:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
Unidad Hepatica, Hospital General Universitario, Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
Unidad Hepatica, Hospital General Universitario, Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
Unidad Hepatica, Hospital General Universitario, Alicante, Spain
Rodríguez M:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Unidad Hepatica, Hospital General Universitario, Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Unidad Hepatica, Hospital General Universitario, Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Servicio de Farmacia, Hospital General Universitario, Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
Gómez L:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital General Universitario, Alicante, Spain
Such J:
Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
Case Western Reserve University, Ohio, OH, USA
:
Servicio de Cirugía General y del Aparato Digestivo, HGUA, Alicante, Spain
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
:
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain.
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
Dpto. Medicina Clínica, Universidad Miguel Hernández, San Juan, Spain.
gold, Green Published
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