Insulin discontinuation after conversion from tacrolimus (TAC) to cyclosporin microemulsion (CSA) in liver transplant (LTx) patients with new onset diabetes after transplantation (NODAT)

A.P-14

“Is direct surgical closure of a wound contaminated by multiresistant bacteria safe in immunocompromised patients?

Introduction/Purpose Critically ill, immunocompromised patients run a high risk of infection and dehiscence of surgical wounds, where bacterial growth may continue, even after prolonged antibiotic treatment. Because guidelines are not available, we aimed to investigate whether it is safe to close wounds growing multiresistant bacteria. Materials and Methods Immunocompromised patients with a dehiscent and infected abdominal wound were collected from November 2008 to November 2011. Immune deficiency was due to organ transplantation, renal failure, HIV, or multiorgan failure. Patients treated before March 2010, were treated with wound debridement and secondary intention healing. Patients presenting afterwards were treated with the following protocol: serial wound debridement, irrigation, and negative pressure dressing. Once wounds had a clinically acceptable appearance, they were primarily closed, despite positive microbiological cultures. Results 13 patients (mean age 56 years, 8 male) were included, 4 were left to heal by secondary intention, 9 were treated with the protocol mentioned above. 10 patients were transplanted (9 liver, 1 kidney), 1 HIV infected, 2 hemodialysed. All the patients had multiple systemic positive cultures. Wounds swabs and biopsies showed growth of multiresistant Acinetobacter Baumanii (6), enterococcus faecium (3), Staph aureus (2), E.coli (1), Klebsiella Pneumoniae (1) Healing was obtained in 3 of the 4 patients in the secondary intention healing group (mean healing time 81days, one death) and in all the patients of the treated group (mean 28 days). No local or systemic complications related to the wound closure arose (minimum follow-up 6 months). Conclusion Serial debridement, negative pressure dressing, and closure seem to lead to durable healing even in a population of critically ill, immunocompromised patients and in a shorter time than secondary intention healing. Closure of a clinically healthy wound, despite positive microbiological swabs, may be reasonable

Conversion from tacrolimus (TAC) to cyclosporine microemulsion (CSA) in patients with new onset diabetes after transplantation (NODAT) improves both fasting and pre-post prandial blood glucose

A 55

HHV-6A in syncytial giant-cell hepatitis

Herpes virus 6, variant A could be the etiological agent of a rare form of hepatitis named syncytial giant cell hepatiti

Prospective randomized multicentre phase III study of liver perfusion with HTK solution compared with UW OR celsior solutions in the setting of liver transplantation

A62

Performance of tests for latent tuberculosis in different groups of immunocompromised patients

BACKGROUND: Immunocompromised persons infected with Mycobacterium tuberculosis (MTB) have increased risk of tuberculosis (TB) reactivation, but their management is hampered by the occurrence of false-negative results of the tuberculin skin test (TST). The T-cell interferon (IFN)-gamma release blood assays T-SPOT.TB (TS.TB) [Oxford Immunotec; Abingdon, UK] and QuantiFERON-TB Gold In-Tube (QFT-IT) [Cellestis Ltd; Carnegie, VIC, Australia] might improve diagnostic accuracy for latent TB infection (LTBI) in high-risk persons, although their performance in different groups of immunocompromised patients is largely unknown.METHODS AND RESULTS: Over a 1-year period, we prospectively enrolled patients in three different immunosuppressed groups, as follows: 120 liver transplantation candidates (LTCs); 116 chronically HIV-infected persons; and 95 patients with hematologic malignancies (HMs). TST, TS.TB, and QFT-IT were simultaneously performed, their results were compared, and intertest agreement was evaluated. Overall, TST provided fewer positive results (10.9%) than TS.TB (18.4%; p < 0.001) and QFT-IT (15.1%; p = 0.033). Significantly fewer HIV-infected individuals had at least one positive test (9.5%) compared with LTCs (35.8%; p < 0.001) and patients with HMs (29.5%; p < 0.001). Diagnostic agreement between tests was moderate (kappa = 0.40 to 0.65) and decreased in the HIV-infected group when the results of the TS.TB were compared with either TST (kappa = 0.16) or QFT-IT (kappa = 0.19). Indeterminate blood test results due to low positive control values were significantly more frequent with QFT-IT (7.2%) than with TS.TB (0.6%; p < 0.001).CONCLUSIONS: Blood tests identified significantly more patients as being infected with MTB than TST, although diagnostic agreement varied across groups. Based on these results, we recommend tailoring application of the new blood IFN-gamma assays for LTBI in different high-risk groups and advise caution in their current use in immunosuppressed patients

A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the Liver Match study

To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry