RESUMEN
Background: Candidia is the most common fungal infection affecting the transplant recipients. Regular monitoring of at-risk patients by detection of circulating Mannan antigen is an aid in early diagnosis of Candidaemia
Objectives: determination of the hospital risk factors for developing Candidaemia, the average time for occurrence of Candidaemia among living donor liver transplant [LDLT] recipients andevaluation of the value of Mannan antigen in early detection of Candidaemia
Methodology: This study was conducted on 50 LDLT recipients. All patients were subjected to history taking and complete medical examination. Blood culture was done for detection of Candidaemia and serum Mannan antigen level was measured by EIA technique every five days postoperative for six times
Results:During the first month postoperative 7/50 cases [14%] of our LDLT patients had Candidaemia .The cultures done on the 5th day, were negative for all patients, however serum Mannan antigen was positive in 3 cases [sensitivity 42.9%, specificity 95.3%]. In the 10th day only 4 cases were positive by blood culture [sensitivity 57.1%, specificity 100%]., while serum Mannan antigen was detected in the all seven cases [sensitivity 100% specificity 95.3%]. On the 15th day,2 new cases became positive by blood culture [sensitivity 85.7%,specificity 100%], while serum Mannan antigen was still detected in the all 7 cases of Candidaemia [sensitivity 100% specificity 95.3%]. Finally on 20rh day postoperative, the last case tested positive by blood culture [sensitivity 71.4%, specificity 85.7%]
Conclusion: Serum Mannan antigenis a good tool for early detection of Candidaemia in LDLT recipients
RESUMEN
To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of [50.1%]. The most frequent complication was infection [21.1%] [intraabdominal collections], followed by biliary leak [18.2%]. Two donors had major complications: one had portal vein thrombosis [PVT] treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely [n=90] with no epidural hematoma despite significantly elevated prothrombin time [PT] and international normalization ratio [INR] postoperatively, reaching the maximum on Day 1 [16.9 +/- 2.5 s and 1.4 +/- 0.2, P < 0.05 when compared with baseline]. Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05 +/- 0.18 mg/dL on Day 1 and 2.3 +/- 0.83 mg/dL on Day 3 postoperatively. Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting