Effects of Infection on Post-Transplant Outcomes: Living versus Deceased Donor Liver Transplants

Abstract

Introduction:Post-transplant infections have been studied widely but data on comparisons of deceased donor liver transplants (DDLT) and living donor liver transplants (LDLT), type and timings of infections, and their relations to outcomes are not explored. Material and methods: We analysed data from 612 participants of the Adult-to-Adult Living Donor Liver Transplantation Study (A2ALL), a retrospective data set of LDLT and DDLT. We compared the type and timing of the first post-transplant infection in relation to transplant outcomes between the two groups. Results: Out of 611 patients, 24.5% experienced the first post-transplant infection, the majority of which were bacterial (35.3%), followed by fungal (11%) and viral infections (4.2%). There was no significant difference in the rate, type or timing of infection between LDLT and DDLT. Patients with late (> 1 year) first infection were 1.8 times more likely to die (95% CI: 1.12-2.98, p = 0.015) and 9 times more likely to have graft failures (95% CI: 3.26-24.8, p < 0.001). DDLT recipients who experienced bacterial infection had a significantly lower survival rate compared to LDLT recipients (p < 0.001). Conclusions: Late infection is associated with lower survival in both DDLT and LDLT. Bacterial infection might be more detrimental for DDLT than LDLT. Late infection should be managed aggressively to improve outcomes. a high clinical burden, with 85% occurring 6 months after transplantation [6]. These conflicting reviews on early and late post-transplant infections and their effect on outcomes in transplant recipients need further exploration to decrease post-transplant morbidity and mortality.Moreover, immunologic and technical advances have improved infection control and post-transplant graft and patient survival, but improvements in immune monitoring and rejection management are required to increase the rates of re-transplantation success [7]. Re-transplant outcomes are poorly understood in liver transplants especially amongst patients receiving living donor transplants. It has been reported that re-transplantation outcomes after living donor

Diagnostic inflammatory markers of acute cholangitis in liver transplant recipients

“…1,2 AC occurs in 8-12% of patients and has the highest incidence, 21.8/1000 person-years, in the first 5 years after liver transplantation (LTx). 1,3,4 Infection in immunosuppressed solid organ transplant recipients is difficult to diagnose because symptoms and clinical signs such as fever and raised white blood cell count (WBC) may be subtle or absent. 5 AC after LTx is commonly associated with anastomotic or non-anastomotic biliary strictures.…”

“…Bacterial and fungal infections, including acute cholangitis (AC), develop in up to 46% of liver transplant (LT) recipients and account for 2% of re‐liver transplantations and 20% of the overall mortality 1,2 . AC occurs in 8–12% of patients and has the highest incidence, 21.8/1000 person‐years, in the first 5 years after liver transplantation (LTx) 1,3,4 .…”

“…Bacterial and fungal infections, including acute cholangitis (AC), develop in up to 46% of liver transplant (LT) recipients and account for 2% of re‐liver transplantations and 20% of the overall mortality 1,2 . AC occurs in 8–12% of patients and has the highest incidence, 21.8/1000 person‐years, in the first 5 years after liver transplantation (LTx) 1,3,4 . Infection in immunosuppressed solid organ transplant recipients is difficult to diagnose because symptoms and clinical signs such as fever and raised white blood cell count (WBC) may be subtle or absent 5 .…”