Oxygen “therapy” for infection in liver transplant surgery: less is more, enough is enough

Abstract

During the early post-transplantation period, healthcare-acquired bacterial and fungal infections are the most common types of infection encountered in liver transplant recipients [1]. Because the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen [2], the issue of high-dose oxygen therapy for infection in liver transplantation raises interests. Postoperative infections in the 30-day post-transplant period, as the primary outcome measure, were higher in the 80% group (34% vs. 23.2%, no statistical significance) as compared to the 28% group [7]. [...]the 80% group suffered more frequently severe complications (43.6% vs. 28.3%) in the 90 days after transplantation, stayed longer in the intensive care unit, and had higher bilirubin concentration over the first 5 post-transplant days [7]. Conversely, a more detailed comparison revealed that the increased severe morbidity rate in the 80% group was largely due to a higher number of complications potentially caused by technical reasons, such as hemorrhage, hepatic artery thrombosis, and biliary leaks [7]. [...]despite that severe complications were significantly more frequent in patients assigned to 80% FiO2, Figiel et al.’s study does not prove the direct causative effect of high FiO2 on severe morbidity [7].