Perioperative bacterial infections in deceased donor and living donor liver transplant recipients

Abstract

Background: Deceased donor (DDLT) and living donor (LDLT) liver transplant (LT) is in vogue in several centers in India. Most centers are resorting to LDLT as a preferred surgery due to shortage of deceased donor liver. The risk of infection and its effect on survival in both groups of recipients from the Indian subcontinent are not known. The study was conducted to compare the bacterial infection rates among LDLT and DDLT recipients and their impact on survival at a tertiary referral center.

Methods: Retrospective data on 67 LT recipients were reviewed. Data on pre-, per-, and postoperative bacterial infection rates and the common isolates were obtained.

Results: Thirty-five patients had LDLT and 32 had DDLT. The prevalence of pre-operative bacterial infection and the isolates was similar in both groups. The perioperative bacterial infection rates were significantly higher in DDLT recipients (P < 0.01) (relative risk: 1.44 95% confidence interval 1.04-1.9). In both LDLT and DDLT, the common source was urinary tract followed by bloodstream infection. The common bacterial isolates in either transplant were Klebsiella followed by Escherichia coli, Pseudomonas spp. and nonfermenting gram-negative bacteria. Six patients (four LDLT; two DDLT) were treated for tuberculosis. Among the risk factors, cold ischemic time, and duration of stay in the intensive care unit was significantly higher for DDLT (p < 0.01). The death rates were not significantly different in the two groups. However, the odds for death were significantly high at 26.8 (p < 0.05) for postoperative bacterial infection and 1.8 (p < 0.001) for past alcohol.

Conclusion: Liver transplant recipients are at high-risk for bacterial infection irrespective of type of transplant, more so in DDLT.

Keywords: AFB, acid fast bacilli; ATT, anti-tuberculous treatment; BAL, bronchoalveolar lavage; BSI, bloodstream infections; Bacteria; CIT, cold ischemic time; CLSI, Clinical and Laboratory Standards Institute; CRP, C-reactive protein; DDLT, deceased donor liver transplant; E. coli, Escherichia coli; ET, endotracheal; ICU, intensive care unit; K. pneumonia, Klebsiella pneumonia; LDLT, living donor liver transplant; LT, liver transplant; MELD, model for end-stage liver disease; MRSA, methicillin-resistant Staphylococcus aureus; NFGNB, nonfermenting gram-negative bacilli; P. aeruginosa, Pseudomonas aeruginosa; RFA, radiofrequency ablation; RR, relative risk; TACE, transarterial chemoembolization; TB, tuberculosis; infection; liver transplant.