Asian Transplantation Week 2017
Liver Transplantation
Impact of Pretransplant Infections on Clinical Course in Liver Transplant Recipients

https://doi.org/10.1016/j.transproceed.2018.01.036Get rights and content

Abstract

Background

Uncontrolled infections are known to be an absolute contraindication for liver transplantation; however, the posttransplant prognosis of recipients treated for pretransplant infection is unclear. The aim of this study was to analyze pretransplant infections among liver transplant recipients and to determine their impact on posttransplant clinical outcomes.

Methods

This study retrospectively analyzed 357 subjects who had undergone living-donor liver transplantation between January 2008 and May 2014.

Results

Among 357 recipients, 71 patients (19.8%) had 74 episodes of infectious complications before liver transplantation. These complications consisted of pneumonia (n = 13), spontaneous bacterial peritonitis (n = 12), catheter-related infection (n = 10), urinary tract infection (n = 12), biliary tract infection (n = 6), and skin and soft-tissue infection (n = 3). Twenty-six patients experienced 29 episodes of bacteremia, and the most common pathogens were coagulase-negative staphylococci (n = 8), followed by Klebsiella pneumoniae (n = 7), Staphylococcus aureus (n = 4), and Streptococcus species (n = 3). Twenty-one bacteremic episodes (70%) occurred within 1 month before transplantation (n = 4). Recipients with pretransplant infections had significantly more frequent posttransplant infections (71.8% [51 of 71] vs 47.2% [35 of 286]; P = .0001), posttransplant bacteremia (33.8% [24 of 71] vs 20.3% [58 of 286]; P = .015), and longer posttransplant intensive care unit stays (11.2 ± 10.7 days vs 7.3 ± 4.2 days; P = .0004) than those without pretransplant infections. However, episodes of rejection (P = .36), length of hospitalization (P = .10), 28-day mortality (P = .31), and 1-year mortality (P = .61) after transplantation were not significantly different between the 2 groups.

Conclusions

Pretransplant infection had an impact on posttransplant morbidity, although not on rejection and mortality. Alertness for posttransplant infection and proper management (including effective antimicrobial coverage) would improve patient morbidity.

Section snippets

Patients and Methods

We reviewed the medical records of 357 subjects who underwent living-donor liver transplantation at Seoul St. Mary's Hospital, a 1200-bed tertiary care university hospital, in Seoul, Republic of Korea, between January 2008 and May 2014. Information was collected on demographic characteristics, preoperative infections, and clinical outcomes. Patients were divided into 2 groups depending on whether they had pretransplant infections. These infections were diagnosed based on clinical, laboratory,

Results

Among 357 recipients, 71 patients (19.8%) had 74 episodes of infectious complications before liver transplantation; these consisted of pneumonia (n = 13), spontaneous bacterial peritonitis (n = 12), catheter-related infection (n = 10), urinary tract infection (n = 12), biliary tract infection (n = 6), and skin and soft-tissue infection (n = 3) (Table 1). Causative pathogens are listed in Table 1 according to the infection site. Gram-positive cocci, primarily Enterococcus species and

Discussion

Patients with end-stage liver disease are vulnerable to infection because of their impaired immunity, bacterial translocation from the intestine, and frequent hospitalizations [1], [2], [3]. Previous studies showed that bacterial infections occurred in 27% to 38% of patients with acute-on-chronic liver failure–compensated liver cirrhosis and that spontaneous bacterial peritonitis, as well as infections of the urinary tract and respiratory tract, were frequent [6], [7]. In the present study,

Conclusions

Our study showed the impact of pretransplant infection on posttransplant morbidity but not on rejection or mortality. According to the patients' conditions, manageable pretransplant infection would not be an absolute contraindication for liver transplantation. Alertness for increased risk of posttransplant infection and prompt effective antimicrobial coverage are the cornerstones of patient survival.

References (11)

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These authors contributed equally to this article.

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