Background
Infections still represent the main factors influencing morbidity and mortality following liver transplantation. This study is to evaluate the incidence and risk factors for infection and survival after liver transplantation.
Methods
We retrospectively examined medical records in 210 recipients who underwent liver transplantation between April 2015 and October 2017 in our center.
Results
During the median follow-up days of 214, the incidence of infection after liver transplantation was 46.7% (n=98): namely, pneumonia (43.4%), biliary tract infection (21.9%) and peritonitis (21.4%). Among the pathogens in pneumonia, the most frequently isolated was Acinetobacter baumanii (23.5%) and Klebsiella pneumoniae (21.1%). For biliary tract infection, the first rank was Strenotrophomonas maltophilia (14.0%) and then Klebsiella pneumoniae (11.6%). Pseudomonas aeruginosa, Strenotrophomonas maltophilia, and Klebsiella pneumoniae accounted for 21.4%, 11.9% and 11.9% of pathogens in peritonitis, respectively. The independent risk factors for infection after liver transplantation are model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score, total blood loss in operation and duration of drainage tube. All-cause mortality was 11.0% (n=23). The prognostic factors for postoperative infection in transplant recipients are infection, especially pneumonia within 2 weeks before transplantation, complication with impaired renal function and higher MELD or PELD score after 7 days of transplantation. Kaplan–Meier curves of survival showed that recipients with infection within 2 weeks before transplantation had a significantly lower cumulative survival rate compared with those without infection (66.7% vs 91.9%, HR=4.480, 95% CI, 3.377-47.85; p<0.001).
Conclusions
Infection, especially pneumonia within 2 weeks before transplantation are independent prognostic factors for postoperative infection in transplant recipients.