Korean J Intern Med.  2018 Jul;33(4):798-806. 10.3904/kjim.2017.230.

Predictors of postoperative infectious complications in liver transplant recipients: experience of 185 consecutive cases

• Lim S
• Kim EJ
• Lee TB
• Choi BH
• Park YM
• Yang K
• Ryu JH
• Chu CW
• Lee SJ

• KMID: 2416007
• DOI: http://doi.org/10.3904/kjim.2017.230

Abstract

BACKGROUND/AIMS
Infections following liver transplant (LT) remain a major cause of mortality. This study was conducted to evaluate risk factors for infection and to review clinical characteristics.
METHODS
Medical records of patients who underwent LT from 2010 to 2014 were retrospectively analyzed. Binary logistic regression analysis was used to investigate risk factors of infection. Kaplan-Meier analysis was used to predict prognosis of infected and non-infected groups.
RESULTS
Of 185 recipients, 89 patients experienced infectious complications. The median follow-up period was 911 days (range, 9 to 2,031). The infected group had higher 1-year mortality (n = 22 [24.7%] vs. n = 8, [8.3%], p = 0.002), and longer postoperative admission days (mean: 53.7 ± 35.8 days vs. 28.3 ± 13.0 days, p < 0.001), compared to the non-infected group. High preoperative Model for End-Stage Liver Disease (MELD) score (odds ratio [OR], 1.057; 95% confidence interval [CI], 1.010 to 1.105; p = 0.016), deceased-donor type (OR, 5.475; 95% CI, 2.442 to 12.279; p < 0.001), and acute rejection (OR, 3.042; 95% CI, 1.241 to 7.454; p = 0.015) were independent risk factors associated with infection. Intra-abdominal infection (n = 35, 20.8%) was the major infectious complication. Among identified bacteria, Enterococcus species (28.4%) were major pathogens, followed by Escherichia coli and Klebsiella species.
CONCLUSIONS
High preoperative MELD score, deceased-donor type, and acute rejection were risk factors associated with infection. To prevent infections following surgery, it is important to determine the appropriate time of operation before the recipient has a high MELD score.

Keyword

Liver transplantation; Infection; Risk factors

MeSH Terms

Bacteria
Enterococcus
Escherichia coli
Follow-Up Studies
Humans
Intraabdominal Infections
Kaplan-Meier Estimate
Klebsiella
Liver Diseases
Liver Transplantation
Liver*
Logistic Models
Medical Records
Mortality
Prognosis
Retrospective Studies
Risk Factors
Transplant Recipients*