Journal of Hepatology
Volume 32, Issue 1 , Pages 142-153 , January 2000

Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document

  • Antoni Rimola

      Affiliations

    • Corresponding Author InformationAntoni Rimola, Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. Tel: 34 93 227 5499. Fax: 34 93 451 5522.
    • Liver Unit, Hospital Clinic, Barcelona, Spain
    • ,
  • Guadalupe García-Tsao

      Affiliations

    • Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
    • ,
  • Miquel Navasa

      Affiliations

    • Liver Unit, Hospital Clinic, Barcelona, Spain
    • ,
  • Laura J.V. Piddock

      Affiliations

    • Department of Infection, University of Birmingham, Birmingham, United Kingdom
    • ,
  • Ramon Planas

      Affiliations

    • Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
    • ,
  • Brigitte Bernard

      Affiliations

    • Service d'Hépato-Gastro-Entérologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
    • ,
  • John M. Inadomi

      Affiliations

    • Veterans Administration Medical Center, Albuquerque, USA
    • ,
  • the International Ascites Club

References 

  1. Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology. 1998;27:264–272
  2. Rimola A. Infectionsin liver disease. In:  McIntyre N,  Benhamou JP,  Bircher J,  Rizzetto M,  Rodés J editor. Oxford Textbook of Clinical Hepatology. Oxford: Oxford University Press; 1991;p. 1272–1284
  3. Garcia-Tsao G. Spontaneous bacterial peritonitis. Gastroenterol Clin N Am. 1992;21:257–275
  4. Caly WR, Strauss E. A prospective study of bacterial infectionsin patients with cirrhosis. J Hepatol. 1993;18:353–358
  5. Pinzello G, Simonetti R, Camma C, Dino O, Milazzo G, Pagliaro L, et al.  Spontaneous bacterial peritonitis: an update. Gastroenterol Int. 1993;6:54–60
  6. Bac D-J, Siersema PD, Mulder PGH, DeMarie S, Wilson JHP. Spontaneous bacterial peritonitis: outcome and predictive factors. Eur J Gastroenterol Hepatol. 1993;5:635–640
  7. Toledo C, Salmerón JM, Rimola A, Navasa M, Arroyo V, Llach J, et al.  Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology. 1993;17:251–257
  8. Llovet JM, Planas R, Morillas R, Quer JC, Cabré E, Boix J, et al.  Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study. Am J Gastroenterol. 1993;88:388–392
  9. Navasa M, Follo A, Llovet JM, Clemente G, Vargas V, Rimola A, et al.  Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology. 1996;111:1011–1017
  10. Hoefs JC, Canawati HN, Sapico FL, Hopkins RR, Weiner J, Montgomerie JZ. Spontaneous bacterial peritonitis. Hepatology. 1982;2:399–407
  11. Pinzello G, Simonetti RG, Craxi A, DiPiazza S, Spanò C, Pagliaro L. Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic patients. Hepatology. 1983;3:545–549
  12. Hoefs JC, Runyon BA. Spontaneous bacterial peritonitis. Disease-a-month. 1985;31:1–48
  13. Almdal TP, Skinhøj P. Spontaneous bacterial peritonitis in cirrhosis. Incidence, diagnosis, and prognosis. Scand J Gastroenterol. 1987;22:295–300
  14. Lafond P, Viallon A, Zéni F, Tardy B, DaCosta A, Page Y, et al.  Justification de la ponction d'ascite systématique chez le patient cirrhotique admis aux urgences. Presse Méd. 1995;24:531–533
  15. Rimola A, Salmerón JM, Clemente G, Rodrigo L, Obrador A, Miranda ML, et al.  Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology. 1995;21:674–679
  16. Runyon BA, Hoefs JC. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology. 1984;4:1209–1211
  17. Terg R, Levi D, Lopez P, Rafaelli C, Rojter S, Abecasis R, et al.  Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease. Dig Dis Sci. 1992;37:1499–1504
  18. Kammerer J, Dupeyron C, Vuillemin N, Leluan G, Fouet P. Apport des examens cytologiques et bacteriologiques du liquide d'ascite cirrhotique au diagnostic de peritonite bacterienne. Med Chir Dig. 1982;11:243–251
  19. Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology. 1988;95:1351–1355
  20. Bobadilla M, Sifuentes J, Garcia-Tsao G. Improved method for bacteriological diagnosis of spontaneous bacterial peritonitis. J Clin Microbiol. 1989;27:2145–2147
  21. Castellote J, Xiol X, Verdaguer R, Ribes J, Guardiola J, Gimenez A, et al.  Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis. Am J Gastroenterol. 1990;85:1605–1608
  22. Bar-Meir A, Lerner E, Conn HO. Analysis of ascitic fluid in cirrhosis. Am J Dig Dis. 1979;24:136–144
  23. Scemama-Clergue J, Doutrellot-Phillippon C, Metreau J-M, Teisseire B, Capron D, Dhumeaux D. Ascitic fluid pH in alcoholic cirrhosis: a reevaluation of its use in the diagnosis of spontaneous bacterial peritonitis. Gut. 1985;26:332–335
  24. Garcia-Tsao G, Conn HO, Lerner E. The diagnosis of bacterial peritonitis: comparison of pH, lactate concentration and leukocyte count. Hepatology. 1985;5:91–96
  25. Yang C-Y, Liaw Y-F, Chu C-M, Sheen I-S. White count, pH and lactate in ascites in the diagnosis of spontaneous bacterial peritonitis. Hepatology. 1985;5:85–90
  26. Stassen WN, McCullough AJ, Bacon BR, Gutnick SH, Wadiwala IM, McLaren C, et al.  Immediate diagnostic criteria for bacterial infection of ascitic fluid: evaluation of ascitic fluid polymorphonuclear leukocyte count, pH and lactate concentration, alone or in combination. Gastroenterology. 1986;90:1247–1254
  27. Pinzello G, Virdone R, Lojacono F, Ciambra M, Dardanoni G, Fiorentino G, et al.  Is the acidity of ascitic fluid a reliable index in making the presumptive diagnosis of spontaneous bacterial peritonitis?. Hepatology. 1986;6:244–247
  28. Attali P, Turner K, Pelletier G, Ink O, Etienne JP. pH of ascitic fluid: diagnostic and prognostic value in cirrhotic and noncirrhotic patients. Gastroenterology. 1986;90:1255–1260
  29. Albillos A, Cuervas-Mons V, Millán I, Cantón T, Montes J, Barrios C, et al.  Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology. 1990;98:134–140
  30. Runyon BA, Antillon MR. Ascitic fluid pH and lactate: insensitivity and nonspecific tests in detecting ascitic fluid infection. Hepatology. 1991;13:929–935
  31. Runyon BA. Ascites and spontaneous bacterial peritonitis. In:  Feldman M,  Scharschmidt BF,  Sleisenger MH editor. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Pathophysiology/Diagnosis/Management, 6th ed, vol 2. Philadelphia: W.B. Saunders Co; 1998;p. 1310–1313
  32. Hoefs JC. Increase in ascites WBC and protein concentrationsduring diuresis in patients with chronic liver disease. Hepatology. 1981;1:249
  33. Kline MK, McCallum RW, Guth PH. The clinical value of ascitic fluid culture and leukocyte count studies in alcoholic cirrhosis. Gastroenterology. 1976;70:408–412
  34. Wilson JAP, Suguitan EA, Cassidy WA, Parker RH, Chan CH. Characteristics of ascitic fluid in the alcoholic cirrhotic. Dig Dis Sci. 1979;24:645–648
  35. Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C, et al.  Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. J Hepatol. 1990;10:327–331
  36. Runyon BA. Monomicrobial non-neutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology. 1990;12:710–715
  37. Pelletier G, Lesur G, Ink O, Hagege H, Attali P, Buffet C, et al.  Asymptomatic bacterascites: is it spontaneous bacterial peritonitis?. Hepatology. 1991;14:112–115
  38. Chu C-M, Chang K-Y, Liaw Y-F. Prevalence and prognostic significance of bacterascites in cirrhosis with ascites. Dig Dis Sci. 1995;40:561–565
  39. Forné M, Bory F, Sánchez C, Viver JM. Bacterascitis asintomática. Evolución favorable de un caso no tratado. Gastroenterol Hepatol. 1986;9:351–353
  40. Rimola A, Bory F, Planas R, Xaubet A, Bruguera M, Rodés J. Infecciones bacterianas agudas en la cirrosis hepática. Gastroenterol Hepatol. 1981;9:453–459
  41. Runyon BA, Hoefs JC. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology. 1984;4:447–450
  42. Garrison RN, Cryer HM, Howard DA, Polk HC. Clarification of risk factors for abdominal operationsin patients with hepatic cirrhosis. Ann Surg. 1984;199:648–655
  43. Runyon BA, Hoefs JC. Spontaneous vs. secondary bacterial peritonitis. Differentiation by response of ascitic fluid neutrophil count to antimicrobial therapy. Arch Intern Med. 1986;146:1563–1565
  44. Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology. 1990;98:127–133
  45. Felisart J, Rimola A, Arroyo V, Perez-Ayuso RM, Quintero E, Ginés P, et al.  Cefotaxime is more effective than is ampicillintobramycin in cirrhotics with severe infections. Hepatology. 1985;5:457–462
  46. Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. Gastroenterology. 1991;100:1737–1742
  47. Moreau L, Durand H, Biclet P. Cefotaxime concentrationsin ascites. J Antimicrob Chemother. 1980;6(suppl A):121–122
  48. Runyon BA, Akriviadis EA, Sattler FR, Cohen J. Ascitic fluid and serum cefotaxime and desacetyl cefotaxime levels in patients treated for bacterial peritonitis. Dig Dis Sci. 1991;12:1782–1786
  49. Mercader J, Gomez J, Ruiz J, Garre MC, Valdes M. Use of ceftriaxone in the treatment of bacterial infectionsin cirrhotic patients. Chemotherapy. 1989;35(suppl 2):23–26
  50. Rimola A, Titó L, Llach J, Salmerón JM, Marqués F, Badalamenti S, et al.  Efficacy of ceftizoxime in the treatment of severe bacterial infectionsin patients with cirrhosis. Drug Invest. 1992;4(suppl 1):35–37
  51. Gómez-Jiménez J, Ribera E, Gasser J, Artaza MA, DelValle O, Pahissa A, et al.  Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients. Antimicrob Agents Chemother. 1993;37:1587–1592
  52. Mesquita MA, Balbino EPS, Albuquerque RS, Carmona CA, Okubo BT, Lorena SLS, et al.  Ceftriaxone in the treatment of spontaneous bacterial peritonitis: ascitic fluid polymorphonuclear count response and short-term prognosis. Hepato-Gastroenterology. 1997;44:1276–1280
  53. McCormick PA, Greenslade L, Kibbler CC, Chin JK, Burroughs AK, McIntyre N. A prospective randomized trial of ceftazidime versus nethylmicin plus mezlocillin in the empirical therapy of presumed sepsis in cirrhotic patients. Hepatology. 1997;25:833–836
  54. Cabrera J, Arroyo V, Ballesta AM, Rimola A, Gual J, Elena M, et al.  Aminoglycoside nephrotoxicity in cirrhosis. Value of urinary B2-microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology. 1982;82:97–105
  55. Ariza J, Xiol X, Esteve M, Fernández-Bañeres F, Liñares J, Alonso T, et al.  Aztreonam vs. cefotaxime in the treatment of Gram-negative spontaneous bacterial peritonitis in cirrhotic patients. Hepatology. 1991;14:91–98
  56. Grange JD, Amiot X, Grange V, Gutmann L, Biour M, Bodin F, et al.  Amoxicillin-clavulanic acid therapy of spontaneous bacterial peritonitis: a prospective study of twenty-seven cases in cirrhotic patients. Hepatology. 1990;11:360–364
  57. Ricart E, Soriano G, Novella MT, Sabat M, Kolle L, Ortiz J, et al.  Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infectionsin cirrhotic patients. J Hepatol. 2000;32: in press
  58. Silvain C, Breux JP, Grollier G, Rouffineau J, Becq-Giraudon B, Beauchant M. Les septicémies et les infectionsdu liquide d'ascite du cirrhotique peuvent-elles être traitées exclusivement par voie orale?. Gastroenterol Clin Biol. 1989;13:335–339
  59. Ginés P, Rimola A, Planas R, Vargas V, Marco F, Almela M, et al.  Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990;12:716–724
  60. Llovet JM, Rodríguez-Iglesias P, Moitinho E, Planas R, Bataller R, Navasa M, et al.  Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. A retrospective study of 229 spontaneous bacterial peritonitis episodes. J Hepatol. 1997;26:88–95
  61. Novella M, Solà R, Soriano G, Andreu M, Gana J, Ortiz J, et al.  Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology. 1997;25:532–536
  62. Fong T-L, Akriviadis EA, Runyon BA, Reynolds TB. Polymorphonuclear cell count response and duration of antibiotic therapy in spontaneous bacterial peritonitis. Hepatology. 1989;9:423–426
  63. Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al.  Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20:1495–1501
  64. Rimola A, Bory F, Teres J, Perez-Ayuso RM, Arroyo V, Rodes J. Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology. 1985;5:463–467
  65. Bleichner G, Boulanger R, Squara P, Sollet JP, Parent A. Frequency of infectionsin cirrhotic patients presenting acute gastrointestinal haemorrhage. Br J Surg. 1986;73:724–726
  66. Soriano G, Guarner C, Tomás A, Villanueva C, Torras X, González D, et al.  Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage. Gastroenterology. 1992;103:1267–1272
  67. Blaise M, Peteron D, Trinchet J-C, Levacher S, Beaugrand M, Pourriat J-L. Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology. 1994;20:34–38
  68. Bernard B, Cadranel J-F, Valla D, Escolano S, Jarlier V, Opolon P. Prognostic significance of bacterial infection in bleeding cirrhotic patients: a prospective study. Gastroenterology. 1995;108:1828–1834
  69. Pauwels A, Mostefa-Kara N, Debenes B, Degoutte E, Lévy V-G. Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection. Hepatology. 1996;24:802–806
  70. Hsieh W-J, Lin H-C, Hwang S-J, Hou M-C, Lee F-Y, Chang F-Y, et al.  The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding. Am J Gastroenterol. 1998;93:962–966
  71. Bernard B, Grangé JD, Nguyen Khac E, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infectionsin cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology. 1999;29:1655–1661
  72. Titó L, Rimola A, Ginès P, Llach J, Arroyo V, Rodés J. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology. 1988;8:27–31
  73. Silvain C, Mannant P-R, Ingrand P, Fort E, Besson I, Beauchant M. Récidive de l'infection spontanée du liquide d'ascite au cours de la cirrhose. Gastroenterol Clin Biol. 1991;15:106–109
  74. Andreu M, Sola R, Sitges-Serra A, Alia C, Gallen M, Vila MC, et al.  Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterology. 1993;104:1133–1138
  75. Runyon BA. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology. 1986;91:1343–1346
  76. Llach J, Rimola A, Navasa M, Ginès P, Salmerón JM, Ginès A, et al.  Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: relevance of ascitic fluid protein concentration. Hepatology. 1992;16:724–727
  77. Soriano G, Guarner C, Teixidó M, Such J, Barrios J, Enríquez J, et al.  Selective intestìnal decontamination prevents spontaneous bacterial peritonitis. Gastroenterology. 1991;100:477–481
  78. Grangé J-D, Roulot D, Pelletier G, Pariente E-A, Denis J, Ink O, et al.  Norfloxacin primary prophylaxis of bacterial infectionsin cirrhotic patients with ascites: a double-blind randomized trial. J Hepatol. 1998;29:430–436
  79. Rolachon A, Cordier L, Bacq Y, Nousbaum J-B, Franza A, Paris J-C, et al.  Ciprofloxacin and long-term prevention of spontaneous bacterial peritonitis: results of a prospective controlled trial. Hepatology. 1995;22:1171–1174
  80. Singh N, Gayowski T, Yu VL, Wagener MM. Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial. Ann Intern Med. 1995;122:595–598
  81. Bernard B, Grangé JD, Nguyen Khac E, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infectionsin cirrhotic patients with ascites: a meta-analysis. Digestion. 1998;59(suppl 2):54–57
  82. Inadomi J, Sonnenberg A. Cost-analysis of prophylactic antibiotics in spontaneous bacterial peritonitis. Gastroenterology. 1997;113:1289–1294
  83. Younossi ZM, McHutchison JG, Ganiats TG. An economic analysis of norfloxacin prophylaxis against spontaneous bacterial peritonitis. J Hepatol. 1997;27:295–298
  84. Alarcón T, Pita J, López-Brea M, Piddock LJV. High-level quinolone resistance amongst clinical isolates of Escherichia coli and Klebsiella pneumoniae, from Spain. J Antimicrob Chemother. 1993;32:605–609
  85. Richard P, Delangle M-H, Merrien D, Barrillé S, Reynaud A, Minozzi C, et al.  Fluoroquinolone use and fluoroquinolone resistance: is there an association?. Clin Infect Dis. 1994;19:54–59
  86. Peña C, Albareda JM, Pallares R, Pujol M, Tubau F, Ariza J. Relationship between quinolone use and emergence of ciprofloxacin-resistant Escherichia coli in bloodstream infections. Antimicrob Agents Chemother. 1995;39:520–524
  87. Piddock LJV. Mechanisms of resistance to fluoroquinolones: state-of-the-art 1992-1994. Drugs. 1995;49(suppl 2):29–35
  88. Acar JF, Goldstein FW. Trends in bacterial resistance to fluoroquinolones. Clin Infect Dis. 1997;24(suppl 1):S67–S73
  89. Ena J, Lopez-Perezagua MM, Martinez-Peinado C, Cia-Barrio MA, Ruiz-Lopez I. Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis. 1998;30:103–107
  90. Piddock LJV. Fluoroquinolone resistance. Overuse of fluoroquinolones in human and veterinary medicine can breed resistance. Br Med J. 1998;317:1029–1030
  91. D'Antonio D, Piccolomini R, Iacone A, Fioritoni G, Parruti G, Betti S, et al.  Comparison of ciprofloxacin, ofloxacin and pefloxacin for the prevention of the bacterial infection in neutropenic patients with haematological malignancies. J Antimicrob Chemother. 1994;33:837–844
  92. Dupeyron C, Mangeney N, Sedrati L, Campillo B, Fouet P, Leluan G. Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis. Antimicrob Agents Chemother. 1994;38:340–344
  93. Nord CE. Effect of quinolones on the human intestinal flora. Drugs. 1995;49(suppl 2):81–85
  94. Carratala J, Fernandez-Sevilla A, Tubau F, Dominguez MA, Gudiol F. Emergence of fluoroquinolone-resistant Escherichia coli in fecal flora of cancer patients receiving norfloxacin prophylaxis. Antimicrob Agents Chemother. 1996;40:503–505
  95. Borzio M, Salerno F, Saudelli M, Galvagno D, Piantoni L, Fragiacomo L. Efficacy of oral ciprofloxacin as selective intestinal decontaminant in cirrhosis. Ital J Gastroenterol Hepatol. 1997;29:262–266
  96. Oethinger M, Jellen-Ritter AS, Conrad S, Marre R, Kern WV. Colonization and infection with fluoroquinolone-resistant Escherichia coli among cancer patients: clonal analysis. Infection. 1998;26:379–384
  97. Terg R, Llano K, Cobas SM, Brotto C, Barrios A, Levi D, et al.  Effects of oral ciprofloxacin on aerobic gram-negative fecal flora in patients with cirrhosis: results of short- and long-term administration with daily and weekly dosages. J Hepatol. 1998;29:437–442
  98. Campillo B, Dupeyron C, Richardet J-P, Mangeney N, Leluan G. Epidemiology of severe hospital-acquired infectionsin patients with liver cirrhosis: effect of long-term administration of norfloxacin. Clin Infect Dis. 1998;26:1066–1070
  99. Altman C, Grange JD, Amiot X, Pelletier G, Lacaine F, Bodin F, et al.  Survival after a first episode of spontaneous bacterial peritonitis. Prognosis of potential candidates for orthotopic liver transplantation. J Gastroenterol Hepatol. 1995;10:47–50
  100. Bac DJ. Spontaneous bacterial peritonitis: an indication for liver transplantation?. Scand J Gastroenterol. 1996;218(suppl.):38–42
  101. Kilpe VE, Krakahuer H, Wren RE. An analysis of liver transplant experience from 37 transplant centers as reported to Medicare. Transplantation. 1993;56:554–561
  102. European Liver Transplant Registry Data analysis 05/1968-06/1997 Hospital Paul Brousse Villejuif France

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Journal of Hepatology
Volume 32, Issue 1 , Pages 142-153 , January 2000

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