Spontaneous bacterial peritonitis: An indication for liver transplantation?

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with cirrhosis and ascites with a poor prognosis. The survival pattern and the reasons for not performing a liver transplantation after an episode of SBP were analysed. Methods: A retrospective analysis during the period 1987-1992 in a tertiary referral and liver transplantation centre. Results: Sixty episodes of SEP were diagnosed in 52 patients with ascites. Thirty-two percent of the patients died within 30 days and 78% within 1 year. Forty patients who survived less than 1 year did not receive a liver transplantation for the following reasons: death within 30 days (n = 12), age above 65 years (n = 10), medical contraindications (n = 6), active alcohol abuse (n = 6), refusal of transplantation (n = 2), death while being analysed for, or awaiting transplantation (n = 4). Two patients had an auxiliary liver transplantation but died postoperatively. Conclusion: SBP is a serious complication in patients with cirrhosis and ascites, with a high first-year mortality and a high recurrence rate. Although long-term survival after an episode of SBP is possible, liver transplantation should be considered for the patients with a progressive liver disease after a first episode of SBP.