Multi-drug Resistant Organism Infection After Liver Transplantation: A Single-center Experience

[Objective] Liver transplantation has become the most effective method for the treatment of end-stage liver disease,but the occurrence of multi-drug resistant organism(MDRO)infection after transplantation seriously affects the prognosis of patients.According to the experience of transplantation centers worldwide,there are many risk factors for MDRO infection,such as elderly donor and recipient,low immune function,hypoproteinemia,massive intraoperative blood loss,postoperative ICU monitoring and reoperation.Considering the complexity of liver transplantation,the high incidence rate and mortality rate of MDRO infection after liver transplantation,it is necessary to summarize the risk factors of MDRO infection after liver transplantation in our transplantation center from preoperative,intraoperative and postoperative aspects,so as to provide theoretical basis of prevention and treat strategies for the prevention of MDRO infection during postoperative period.[Methods] The clinical data of 77 recipients undergoing liver transplantation between February 2015 and April 2020 were retrospectively analyzed.According to the incidence of MDRO infection,all recipients were divided into the non-MDRO infection group(n=51)and MDRO infection group(n=26).Combined with the actual situation of our center and the experience of various transplantation centers worldwide,the following potential factors were considered: gender,age,primary disease,MELD score,Child-Pugh grade,length of hospital stay,preoperative infection,donor infection,operative time,anhepatic period,blood loss,blood transfusion and tracheal intubation time.The infection rate and strain distribution of MDRO in liver transplant recipients were summarized.The risk factors of MDRO infection in liver transplant recipients were identified.Clinical prognosis of all recipients was statistically compared between two groups.[Results] All patients were divided into 61 males and 16 females,with an average age of(45 ± 13)years.MDRO infection group included 19 cases(73%)of gram-negative MDRO infection,5 cases(19%)of Gram-positive MDRO infection and 2 cases(8%)of both Gram-negative and gram-positive MDRO infection.Among them,10 cases of Acinetobacter baumannii,10 cases of Klebsiella pneumoniae,6 cases of Enterococcus faecium,2 cases of Escherichia coli,1 case of Staphylococcus aureus,1 case of Acinetobacter yoelii and 1 case of Pseudomonas aeruginosa were detected,of which 18 cases were mainly carbapenem resistant.The main sites of infection included lung,abdominal cavity and incision.Univariate analysis showed that postoperative tracheal intubation ≥48 h,length of intensive care unit(ICU)stay ≥72 h,length of hospital stay≥30 d,re-operation,continuous renal replacement therapy(CRRT)and tacrolimus(Tac)blood concentration ≥15 ng/m L were the risk factors for MDRO infection after liver transplantation.Cox regression model indicated that postoperative tracheal intubation≥48 h,re-operation,CRRT and Tac blood concentration ≥15 ng/m L were the independent risk factors for MDRO infection after liver transplantation.The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26)vs.10%(5/51),P=0.01].[Conclusions] Postoperative tracheal intubation ≥48 h,re-operation,CRRT and Tac blood concentration ≥15 ng/m L are independent risk factors of MDRO infection after liver transplantation.Early extubation,closely monitoring FK506 concentration,protection of renal function and avoidance of reoperation may play a positive role in reducing the incidence of MDRO infection and improving the prognosis of patients after liver transplantation.