Liver cirrhosis is a well-known risk factor of
sepsis after emergent gastrointestinal (GI) endoscopy. Elective GI endoscopy before living donor
liver transplantation (LDLT), however, may also carry the septic risk among these patients.
METHODS: This retrospective study reviewed the medical records of 642 cirrhotic recipients who underwent GI 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
antibiotic prophylaxis.
RESULTS: In experience cohort, 36 cases (10.5%) of the 342 LDLT candidates experienced
sepsis within 48 h after endoscopy. The
sepsis rate was significantly higher in patients with hepatic decompensation than patients without (22.2% vs. 9.6% vs. 2.6% in Child C/B/A groups respectively; ×2 = 20.97, P < 0.001). Using multivariate logistic regression analysis, the factors related to post-endoscopy
sepsis were the Child score (OR 1.46; 95% CI 1.24-1.71), Child 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 use of
antibiotic prophylaxis (OR 0.08; 95% CI 0.01-0.64). In validation cohort,
antibiotics were given routinely, and all cases of hepatic
hydrothorax (n = 10) were drained. Consequently, 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 < 0.001).
CONCLUSIONS: