Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: An analysis of the epidemiology, risk factors, and outcomes

Abstract

In recipients of liver transplantation (LT), surgical site infection (SSIs) are among the most common types of infection occurring in the first 60 days after LT. In 2007, the Model for End-Stage Liver Disease (MELD) scoring system was adopted as the basis for prioritizing organ allocation. Patients with higher MELD scores are at higher risk for developing SSIs as well as other health care-associated infections. However, there have been no studies comparing the incidence of SSIs in the pre-MELD era with the incidence in the period since its adoption. Therefore, the objectives of this study were to evaluate the incidence, etiology, epidemiology, and outcomes of post-LT SSIs in those 2 periods and to identify risk factors for SSIs. We evaluated all patients who underwent LT over a 10-year period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). SSI cases were identified through active surveillance. The primary outcome measure was an SSI during the first 60 days after LT. Risk factors were analyzed via logistic regression, and 60-day survival rates were evaluated via Cox regression. We evaluated 543 patients who underwent LT 597 times. The SSI rates in the 2002-2006 and 2007-2011 periods were 30% and 24%, respectively (P 5 0.21). We identified the following risk factors for SSIs: retransplantation, the transfusion of more than 2 U of blood during LT, dialysis, cold ischemia for >400 minutes, and a cytomegalovirus infection. The overall 60-day survival rate was 79%. Risk factors for 60-day mortality were retransplantation, dialysis, and a longer surgical time. The use of the MELD score modified the incidence and epidemiology of SSIs only during the first year after its adoption. Risks for SSIs were related more to intraoperative conditions and intercurrences after LT than to a patient's status before LT.

Carbapenem‐resistant A cinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes

“…Other authors have shown that CRAB is the MDR-GNB that most often colonizes LT recipients before and after transplant. (14,15) Although the prevalence of CRAB colonization was quite high in our patient sample, there are, to our knowledge, no comparative data in the literature regarding the prevalence of CRAB colonization in the context of active, weekly surveillance after LT.…”

Aquisição de bactéria gram-negativa multidroga resistente antes do transplante de fígado: o impacto no desfecho

“…Cold ischemia time longer than 400 minutes has previously been identified as a risk factor for SSI after LT, (32) and in the present study a prolonged total ischemia time was associated with an increased risk for infection by CRPA. In general, it can be assumed that longer ischemia time is associated with slower post-LT recovery of the systemic inflammatory response, as well as, indirectly, longer ICU stays, increased use of invasive devices, and delayed recovery of renal function.…”

“…Other authors have shown that CRAB is the MDR GNB that most often colonizes LT recipients before and after transplant. (32) Although the prevalence of CRAB colonization was quite high in our patient sample, there are, to our knowledge, no comparative data in literature regarding the prevalence of CRAB colonization in the context of active, weekly surveillance after LT.…”

“…Patients undergoing LT due to fulminant hepatitis typically show high MELD scores at the time of transplantation, and such patients also often have longer ICU stays and need dialysis before LT. (32) A high MELD score at LT has been associated with a greater risk of bacterial infection, specifically post-LT bacteremia caused by Enterobacteriaceae. (105) In a univariate analysis, Hsieh et al demonstrated that a high MELD score is a risk factor for A. baumannii infection after LT. (33) This study has demonstrated that the acquisition of MDR GNB in pre-LT can increase the risk for developing infection by these agents in post-LT period.…”

“…(8) In that population, the A. baumannii was the most frequent pathogen isolated from surgical site infections, and 94% of the strains were resistant to carbapenem. (32) The lung is the most common site of infection by this agent in SOT patients. However, particularly in LT patients, intra-abdominal infections are the predominant site in most series.…”