Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Mar 3;8(3):e251333.
doi: 10.1001/jamanetworkopen.2025.1333.

Surgical Site Infections, Risk Factors, and Outcomes After Liver Transplant

Peter W Schreiber  1 , Linard D Hoessly  2 , Katia Boggian  3 , Dionysios Neofytos  4 , Christian van Delden  4 , Adrian Egli  5   6 , Michael Dickenmann  2 , Cédric Hirzel  7 , Oriol Manuel  8   9 , Michael Koller  2 , Simona Rossi  2 , Vanessa Banz  10 , Philippe Compagnon  11   12 , Philipp Dutkowski  13 , Andreas E Kremer  14 , Annalisa Berzigotti  15 , Julien Vionnet  16 , Nicolas Goossens  17   18 , David Semela  19 , Patrizia Künzler-Heule  19 , Christine Bernsmeier  20 , Stefan P Kuster  1   3 , Susanne Stampf  2 , Nicolas J Mueller  1 ; Swiss Transplant Cohort Study
Collaborators, Affiliations
Multicenter Study

Surgical Site Infections, Risk Factors, and Outcomes After Liver Transplant

Peter W Schreiber et al. JAMA Netw Open. .

Abstract

Importance: Surgical site infections (SSIs) are one of the most common health care-associated infections. Surgical site infections can have harmful effects in liver transplant (LT) recipients.

Objective: To assess the incidence of SSI after LT and identify risk factors associated with SSIs and whether SSIs are associated with death and graft loss.

Design, setting, and participants: A multicenter cohort study encompassing data on LT performed at all Swiss transplant centers between May 1, 2008, and September 30, 2020, was conducted. Data analyses were performed in 2023.

Exposure: Liver transplant.

Main outcomes and measures: Frequency of SSIs within 90 days after transplant, risk factors associated with SSIs, and association of SSIs with 1-year death or graft loss. Surgical site infections were defined according to Centers for Disease Control and Prevention criteria with SSIs occurring within 90 days after LT. For association with posttransplant outcomes, 1-year follow-up data were analyzed.

Results: Among 1333 LT recipients in the Swiss Transplant Cohort Study, 1158 adults were included in analyses. Median age was 57.2 (IQR, 49.3-62.8) years and 792 were men (68.4%). Seventy patients (6.0%) had an SSI. Most SSIs were deep incisional (9 [12.8%]) or organ-space infections (54 [77.1%]). In most SSIs (56 [80.0%]), bacteria were detected, most frequently Enterococcus spp (36 of 75 [48.0%]) and Escherichia coli (12 of 75 [16.0%]). In multivariable analysis, prior liver transplant (odds ratio [OR] 4.01; 95% CI, 1.44-11.18; P = .008) and living liver donation (OR, 4.08; 95% CI, 1.37-12.16; P = .01) were independent risk factors associated with SSIs. Surgical site infections were independently associated with graft loss and/or death (hazard ratio [HR], 3.24; 95% CI, 1.82-5.79; P < .001); this association was observed in separate analyses on graft loss (HR, 2.97; 95% CI, 1.32-6.68; P = .02) and death (HR, 3.25; 95% CI, 1.44-7.35; P = .01).

Conclusions and relevance: The findings of this study suggest that prior liver transplant and living liver donation are independent risk factors associated with SSIs and that SSIs are independently associated with graft loss and/or death, highlighting the relevance of this health care-associated infection.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Schreiber reported receiving grants from the University of Zurich during the conduct of the study, a travel grant from Pfizer outside the submitted work; grants from Swiss National Science Foundation to STCS. Dr Kremer reported receiving other from AbbVie, Advanz, Alentis, AlphaSigma, AstraZenca, Avior, Bayer, BMS, CymaBay, Escient, Falk, Gilead, GSK, Guidepoint, Intercept, Ipsen, Mirum, MSD, Novo Nordisk, Roche, Takeda consultancy work outside the submitted work. Dr Mueller reported receiving grants from the Swiss National Science Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Population Selection
SSI indicates surgical site infection; STCS, Swiss Transplant Cohort Study.
Figure 2.
Figure 2.. Temporal Distribution of Detected Pathogens in Surgical Site Infections (SSIs) After Liver Transplant
All Escherichia coli isolates, 3 Enterobacter cloacae isolates, 1 Klebsiella spp isolate, and 1 Serratia marcescens isolate were extended-spectrum β-lactamase producers. None of the Staphylococcus aureus isolates was methicillin-resistant and none of the Enterococcus spp was vancomycin-resistant. In clinically diagnosed SSI, no causative pathogens were detected.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.1342

References

    1. Baganate F, Beal EW, Tumin D, et al. . Early mortality after liver transplantation: defining the course and the cause. Surgery. 2018;164(4):694-704. doi:10.1016/j.surg.2018.04.039 - DOI - PubMed
    1. Bundesamt für Gesundheit. Zahlen zur Spende und Transplantation von Organen in der Schweiz. Accessed month day, year. https://www.bag.admin.ch/bag/de/home/zahlen-und-statistiken/zahlen-fakte...
    1. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-2614. doi:10.1056/NEJMra064928 - DOI - PubMed
    1. Zingg W, Metsini A, Balmelli C, et al. ; Swissnoso Network . National point prevalence survey on healthcare-associated infections in acute care hospitals, Switzerland, 2017. Euro Surveill. 2019;24(32):1800603. doi:10.2807/1560-7917.ES.2019.24.32.1800603 - DOI - PMC - PubMed
    1. Magill SS, Edwards JR, Bamberg W, et al. ; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team . Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801 - DOI - PMC - PubMed

Publication types