Carbapenem-Resistant Klebsiella Pneumoniae Infections Early After Liver Transplantation: A Single-Center Experience

The aims of this study were to define in a cohort of 310 liver transplant recipients, the incidence of post–liver transplantation (LT) non–carbapenem-resistant Klebsiella pneumoniae (CRKP) and CRKP infections, pre- and post-LT CRKP colonization, CRKP-associated mortality, and risk factors for non-CRKP and CRKP infections. Every patient was screened for CRKP immediately before and after LT. The 6-month survival rate was 95%. Fifty-two patients became infected (16.5%): 8 by CRKP (2.5%) and 44 (14%) by a non-CRKP micro-organism. Median onset of CRKP infections occurred at postoperative (POD) 12 (range, 4–70). CRKP colonization occurred in 20 patients (6%): 10 before LT (3 infected and died) and 10 after (5 infected, 3 died). CRKP- versus non-CRKP–infected patients had higher rates of intensive care unit (ICU) and hospital mortality (50% vs 20% and 62.5% vs 36%; P ≤ .001), septic shock (87% vs 34%; P = .0057; confidence interval [CI], 9.8–71.5), prolonged mechanical ventilation (100% vs 64%; P = .043, CI, 3.5–51.9), and renal replacement therapy (87% vs 41%; P = .0177; CI, 2.8–65). The small number of CRKP-infected patients did not allow the definition of specific risk factors for CRKP infection. At univariate analysis, pre- and post-LT colonization (odds ratio [OR], 10.76; CI, 2.6–44; OR, 14.99; CI, 3.83–58.66, respectively), relaparotomy (OR, 9.09; CI, 4.01–20.6), retransplantation (OR, 7.45; CI, 3.45–16), bile leakage (OR, 61.28; CI, 9.23–80), and early allograft dysfunction (EAD; OR, 5.7; CI, 3–10.7) were significantly associated with infections, making CRKP colonization (any time) and post-LT surgical and medical complications critical factors for post-LT CRKP infections.     

Lobar Lung Transplantation From Deceased Donor: Monocentric Experience

Introduction

Lung transplantation is considered a therapeutic option in selected patients affected by end-stage pulmonary disease. The mortality on the waiting list is mainly attributed to the shortage of the donor pool available for transplantation. There are various strategies to overcome this shortage; one of them is lobar transplantation.

Family Therapy and Beyond: Where is the Milan Systemic Approach Today?

This paper reviews the current position of the Milan Approach in the family therapy field. Over the past 20 years this approach has made a major contribution to the development of family therapy theory and practice in the U.K. However, the ideas have been modified in order to fit different client groups in a range of settings; until today, the Milan, or Post-Milan approach is an amalgam of the original concepts and new techniques. This paper describes the development of this approach and highlights the following topics as central to current thinking: language, power, narrative, family resilience, externalising, focusing on change, and solution focused approaches. Several techniques of the Post-Milan approach are demonstrated in a discussion of one case treated by the author.