Infected Bilomas in Liver Transplant Recipients, Incidence, Risk Factors and Implications for Prevention

Bilomas, infected hepatic fluid collections, are a frequent complication of liver transplantation. We report a case‐control cohort study to determine the incidence and microbiologic profile of bilomas and risk factors for biloma formation in 492 patients undergoing liver transplantation from 1994 to 2001. Fifty‐seven patients (11.5%) developed one or more bilomas; 95% in the first year post‐transplantation. The most common initial infecting pathogens were enterococci (37%), one‐half resistant to vancomycin (VRE); coagulase‐negative staphylococci (26%); and Candida species (26%). Infection by coagulase‐negative staphylococci was strongly associated with the presence of a T‐tube (OR 9.60, p = 0.02). In stepwise logistic regression multivariable analyses, hepatic artery thrombosis (OR 90.9, p < 0.0001), hepatic artery stenosis (OR 13.2, p < 0.0001) and Roux‐en‐Y choledochojejunostomy (OR 5.8, p = 0.03) were independent risk factors for biloma formation; ursodeoxycholic acid use was highly protective (OR 0.1, p = 0.002). Strategies to prevent biloma formation must focus on measures to prevent hepatic artery thrombosis and colonization of liver transplant patients by multiresistant nosocomial pathogens. T‐tube drainage post‐transplantation bears reassessment. The protective effect of ursodeoxycholic acid found in this study warrants confirmation in a prospective multicenter, randomized trial.