Evaluation of Nosocomial Infections after ABO-Compatible and Incompatible Liver Transplantations

Abstract

Introduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABOcompatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABOincompatible patients. However, further studies are needed on this topic. Giriş: Günümüzde akut karaciğer yetmezliği ve son dönem karaciğer hastalığında tek tedavi seçeneği karaciğer naklidir. Uygun verici eksikliği ve acil organ gereksinimi sebebiyle ABO uyumsuz karaciğer nakilleri, komplikasyonları sık olmasına rağmen yapılmaya devam etmektedir. Cerrahi tekniklerdeki gelişmeler ve antimikrobiyal profilaksi stratejilerindeki ilerlemelere rağmen, enfeksiyonlar hala önemli bir komplikasyon olup, ölümlerin başlıca sebebi olmaya devam etmektedir. Bu çalışmada, merkezimizde yapılan ABO uyumlu ve uyumsuz karaciğer nakli alıcıları, enfeksiyonlar ve sağkalım yönünden retrospektif olarak incelendi. Abstract Öz