Epidemiology And Risk Factors For Infections After Liver Transplantation

Introduction:Infection is a major cause of post-transplant mortality in liver transplant (LT) recipients. This study seeks to identify the epidemiology and its evolving trends to benefit prophylactic and empiric treatment for liver transplant recipients.Methods:We retrospectively analyzed the frequency and characteristics of post-transplant infections in564recipients, who underwent liver transplantation between January1st,2004and December31st,2009in our center, and evaluated the risk factors of post-transplantation infection.Results:Overall,394patients got at least one kind of infections within the hospitalization time following LT, mobility69.9%; Of the564patients transplanted,41patients (7.3%) died. The mean hospitalization time was42±22(range0～147d). A considerable decrease of incidence rate occurred from2004to2009, and the mortality fluctuated around about5%and had a slight decrease from2004to2009. In total,1771pathogens were isolated. Gram-positive bacteria, Gram-negative bacteria and fungal accounted for28%(496),57.1%(1011) and14.9%(264). The most frequent pathogens were Staphylococcus (18.2%), Stenotrophomonas maltophilia (9.8%), Acinetobacter baumannii (6.6%), Enterococcus (6.0%) and Pseudomonas aeruginosa (5.3%). Kaplan-Meier1-year survival curves showed that patients with infection had a significantly lower cumulative survival rate than whose without infection (82.7%versus90.0%, P<0.01). Multivariate analysis revealed that age>60years (P=0.010), severe hepatitis (P=0.030), cadaveric donor (P=0.000) and post-LT bile leakage (P=0.014) were independent risk factors for infection within hospitalization time after LT. And post-LT bile leakage still need to be identified (95%CI=1.675-108.253, P=0.014). While hepatic carcinoma (P=0.002) showed protective effect compared with tumor-free group for infection.Conclusion:Infection is a frequent complication during hospitalization after LT, and the mortality of infection is still a big challenge for post-LT treatment. Early detection and treatment of infections is necessary to getting a better outcome of patients post-LT. We suggest clinicians improve patients’condition before liver transplantation, especially for patients aged more than60years and those suffered from severe hepatitis.