Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single‐center prospective cohort study

Abstract

Introduction:Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Materials and Methods: Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants;and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols.Results: A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for ≥150 minutes, surgical duration of ≥600 minutes, intraoperative hemorrhage of ≥1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61.

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

“…In contrast with previous research (15)(16)(17), intraoperative blood loss > 500 ml was not significantly associated with postoperative organ/space SSI, which may be due to the prevalence of bloodless surgery. Other risk factors for SSI in previous studies, such as diabetes or perioperative hyperglycemia, obesity, low preoperative albumin and an immunosuppressive status (4,6,(18)(19)(20), did not show any significant relationship with organ/space SSI in our results either.…”

Epidemiology and outcomes of surgical site infections among pediatric liver transplant recipients

“…To date, our study is one of the largest single center studies evaluating risk factors and outcomes associated with SSI following pediatric LT. In this study, the SSI rate (9.5%) was low compared to prior studies, and most SSIs were organ/space infections, which is consistent with other reports 11,14 . Recently, Dohna Schwake et al.…”

“…It is important to note that organ/space SSIs were associated with SG and biliary complications. The association between SSIs and biliary complications has been previously described and has been demonstrated in other cohorts, most often associated with the presence of bile leaks 11,21,22 . This is noteworthy in pediatric LT given the challenges associated with biliary anastomoses in young patients.…”

“…In this study, the SSI rate (9.5%) was low compared to prior studies, and most SSIs were organ/space infections, which is consistent with other reports. 11,14 Recently, Dohna Schwake et al reported a 20% SSI rate in pediatric transplantations. We think this two-fold difference is due to the different study population.…”

“…The association between SSIs and biliary complications has been previously described and has been demonstrated in other cohorts, most often associated with the presence of bile leaks. 11,21,22 This is noteworthy in pediatric LT given the challenges associated with biliary anastomoses in young patients. Nafady-Hego et al reported that 52% of all the infections detected in a large cohort of pediatric LDLT recipients (n = 345) within 3 months post-LT were SSIs.…”