Infection after Adult-to-Adult Living Donor Liver Transplantation

Nah, Yang Won; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Choi, Dong Lak; Ahn, Chul Soo; Park, Dong Eun; Joo, Sun Hyung; Jeon, Jang Yeong; Min, Pyung Chul

Abstract

PURPOSE: Living donor liver transplantation (LDLT) has become an evolving option to overcome the shortage of cadaveric donor organ in adults as well as in children. The purpose of this study was to determine the incidence, timing, sites, and risk factors of infection after adult-to-adult LDLT.
METHODS
The authors performed 104 adult-to-adult LDLT in 103 patients during the period of February 1997 and December 1999. The major indications for transplantation were chronic hepatitis B (53), hepatocellular carcinoma (27), and fulminant hepatitis (10). Right hepatic lobe was used in 54 cases and left lobe in 50. Graft weight-to-standard liver volume of the recipient ranged from 28.91% to 77.43% (mean 47.60%). No patient died during surgery. The incidence, timing, sites, and risk factors of infection after adult- to-adult LDLT were investigated retrospectively.
RESULTS
A total of 114 cases of infection, including 85 bacterial, 3 mycobacterial, 16 fungal and 10 viral infection, developed in 65 (63.1%) patients. Seventy-one cases of infection occurred within 1 month after surgery. Intra-abdominal infection (31), hepato-biliary infection (19), primary bacteremia (12), and pneumonia (10) were the frequent ones, which developed mainly within 1 month after transplantation. Eight of 9 patients with pneumonia that developed early in the postoperative course died. Since January 1999, the incidence of pneumonia declined significantly from 20.0% (7/35) to 2.9% (2/68). Most fungal infection, including 7 cases of intra-abdominal infection, also occurred within 1 month after surgery (13/16). In contrast, all the 10 cases of viral infection developed after 2 months postoperatively. One case each of recurrent hepatitis B, recurrent hepatitis C, and posttransplant lymphoproliferative disorder died. Patients with infection showed significantly lower survival rate than those without infection (66.2% vs. 97.4%, p=0.0009). The indication for transplantation, amount of intraoperative RBC transfusion, and value of prothrombin time at the 7th day after surgery were significant risk factors for early serious infection on multivariate analysis. Urgency of operation was the only significant risk factor for early fungal infection on univariate analysis.
CONCLUSION
For the prevention of early serious infection after liver transplantation, efforts to reduce the amount of intraoperative transfusion and to protect the graft from perioperative insults should be executed. Preemptive anti-fungal therapy is suggested in cases of emergent operation.