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. 2019 May;15(3):656-665.
doi: 10.5114/aoms.2019.84736. Epub 2019 Apr 30.

Risk index for early infections following living donor liver transplantation

Shaimaa Elkholy  1 , Doaa Ahmed Mansour  2 , SamahAbd El-Hamid  3 , Ula M Al-Jarhi  1 , Saeed M El-Nahaas  4 , Sherif Mogawer  1
Affiliations

Risk index for early infections following living donor liver transplantation

Shaimaa Elkholy et al. Arch Med Sci. 2019 May.

Abstract

Introduction: Post-operative infections in patients undergoing living donor liver transplantation (LDLT) are a major cause of morbidity and mortality. This study aims to develop a practical and efficient prognostic index for early identification and possible prediction of post-transplant infections using risk factors identified by multivariate analysis.

Material and methods: One hundred patients with post-hepatitic cirrhosis, HCV positive, genotype 4, Child B/C or MELD score 13-25 undergoing LDLT were included. All potential predictors of infection were analyzed by backward logistic regression. Cut-off values were obtained from ROC curve analysis. Significant predictors were combined into a risk index, which was further tested and compared by ROC curve analysis.

Results: Post-operative infection was associated with a significantly higher mortality (50.7% vs. 33.3%). Total leucocyte count, total bilirubin, early biliary complications, fever and C-reactive protein were found to be independent predictors of early infectious complications after LDLT. The risk index predicted infection with the highest sensitivity and specificity as compared with each predictor on its own (AUC = 0.91, 95% CI: 0.830-0.955, p < 0.0001).

Conclusions: The use of a combined risk index for early diagnosis of post-operative infections can efficiently identify high risk patients.

Keywords: infections; liver transplantation; living donor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Histogram showing the frequency of early infectious complications according to time of occurrence
Figure 2
Figure 2
Common sites of infection in group B
Figure 3
Figure 3
Organisms isolated in group B
Figure 4
Figure 4
Receiver operating characteristic curve (ROC) analysis for sensitivity, specificity and cutoff values for significant predictors of infection: A – total bilirubin, B – biliary complications, C – fever, D – CRP, E – TLC
Figure 5
Figure 5
Receiver operating characteristic curve (ROC) analysis for sensitivity, specificity and cut-off value for the risk index of infection
See this image and copyright information in PMC

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