Backgrounds and Methods: Prophylactic antibiotics is recommended for cirrhotic patients with acute variceal bleeding (AVB) in the guidelines. However, the frequency of prophylactic antibiotics administration and its effect on prognosis in our country is unknown. To address this issue, date from 144 cirrhotic patients with AVB after emergent endoscopic variceal ligation treatment were retrospectively analyzed to evaluate the frequency of prophylactic antibiotics administration and its impact on the incidence of infection and 6-week mortality after ligation therapy.

Results: Prophylactic antibiotics were administered in 16 patients (11.1%). Although infection occurred in 18 patients, there was no significant difference in the occurrence rates of infection between prophylactic and non-prophylactic group (2/16 vs. 16/138, p=0.627). Thirty nine patients, including four cases in prophylactic group and 35 in non-prophylactic group, died within 6 weeks. Prophylactic antibiotics administration did not affect 6-week mortality (p=0.554). Conclusions: The frequency of prophylactic antibiotics administration was low and not related with 6-week mortality. Prospective study is needed to reveal the adequate application of prophylactic antibiotics use for cirrhotic patients with AVB in our country.

Effects of splenectomy on short-term and long-term outcome of patients after living donor liver transplantation (LDLT) were retrospectively evaluated. Subjects were 482 patients receiving LDLT consisting of 302 and 180 patients with and without splenectomy, respectively. At 14 days after LDLT, serum total bilirubin levels were lower and drained ascetic fluid amounts were smaller whereas prothrombin activities (%) were higher in patients with splenectomy than in those without splenectomy. Moreover, percentages of patients complicating post-operative sepsis and those manifesting acute rejection were less in the former patients than in the latter patients. Surgical complications, however, possibly associated with splenectomy occurred in 39 patients; leakage of pancreatic juice in 26 patients, intra-abdominal hemorrhage in 5 patients, portal vein thrombosis in 5 patients, and overwhelming post-splenectomy infections in 3 patients. Cumulative graft survival rates at 6 and 10 years after LDLT were 93.4% and 73.7%, respectively, in patients with splenectomy; both rates were significantly higher than those in patients without splenectomy (84.3% and 64.9%, respectively). A multivariate analysis identified that LDLT without splenectomy and MELD score of 22 or higher were significant factors associated with unfavorable graft outcome within 6 months after the operation. In conclusion, splenectomy is a useful procedure to improve the graft survival in patients receiving LDLT. Technical devises to avoid surgical complications associated splenectomy are required to be established in future.