The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Predictors of postoperative infectious complications in liver transplant recipients: experience of 185 consecutive cases

  • Lim, Seungjin (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Eun Jung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Tae Beom (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Choi, Byung Hyun (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Park, Young Mok (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Yang, Kwangho (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Ryu, Je Ho (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Chu, Chong Woo (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Lee, Su Jin (Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2017.07.05
  • Accepted : 2017.09.28
  • Published : 2018.07.01
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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: $53.7{\pm}35.8$ days vs. $28.3{\pm}13.0$ 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.

Keywords

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