SURVIVAL AFTER A FIRST EPISODE OF SPONTANEOUS BACTERIAL PERITONITIS - PROGNOSIS OF POTENTIAL CANDIDATES FOR ORTHOTOPIC LIVER-TRANSPLANTATION

To determine the potential role of orthotopic liver transplantation (OLT) in cirrhotic patients surviving a first episode of spontaneous bacterial peritonitis (SEP), medical records of 79 patients presenting with a first episode of SEP were reviewed. Of these patients, 37 were selected as potential candidates for OLT using the following criteria: absence of hepatocellular carcinoma; no severe organ failure other than the liver; age less than or equal to 66 years; and survival after SEP > 60 days. Survival time was calculated from the day of SEP diagnosis. Prognostic value of clinical, biological and bacteriological data recorded at the time of SEP was determined using univariate and multivariate analysis (Cox's regression model). Survival rate of the potential candidates for OLT at 3 months, I year and 2 years was 94, 46 and 30%, respectively. Serum creatinine value (P=0.001) and Pugh score (P=0.005) were independently correlated with death. The 1 year survival rate was 80% for the 11 patients with a Pugh score <10, and 26% for the 26 patients with a Pugh score greater than or equal to 10. Our results suggest that after SEP, OLT should be considered in patients with severe liver disease. Survival of patients with a moderate liver disease (i.e. Pugh score <10) might be relatively high.