Risk Factors For Infection After DCD Liver Transplantation

Backgroud/aims:Infection for liver transplantation is a common cause of mortality. Donation after cardiac death (DCD) has been advised as a approach to increase the donor pool.The purpose of our study was to evaluate the incidence, timing, location, and risk factors for bacterial and fungal infections after DCD liver transplantation and make it clear there is any relationship between infection and survival of DCD liver transplantation recipients.Method:We retrospectively reviewed231consecutive patients undergoing DCD liver transplantation between2010October and2015January at the Liver Transplant Center, First Affiliated Hospital, Zhejiang University School of Medicine.Results:The main reason for DCD liver transplantation was liver cancer(112/231,48.5%) in our center. A total of120patients (51.9%) developed at least one bacterial or fungal infection episode. The predominant infection site was the respiratory tract, followed by blood stream. Bacterial infections represented the most frequent event (86%), and fungal infections were14%. Most of the infection occurred within the first week after liver transplantation (59.2%). Recipients respiratory support time more than7days (P=0.041), hospital day post-transplantation more than24d (P=0.002) and renal failure after DCD liver transplantation (P=0.039) were independent predictors of bacterial and fungal infection. The area under the receiver operating characteristic (ROC) curve (AUC) of transplantation infection risk assessment model is0.788.The1-, and3-years survival rates for recipients without infection were significantly higher than those of recipients with infection (96.1%and89.0%versus81.5%and75.9%, P=0.007).Conclusion:In conclusion, this is the first study that offers detailed data showing the timing and incidence of bacterial and fungal infection among adult DCD liver transplantation recipients. Bacterial and fungal infection occurs at a high rate in first week after DCD liver transplantation, especially in patients with prolonged respiratory support time, longer hospital day and renal failure. To avoid high mortality after DCD liver transplantation, a more accurate infection control project should be established.