A Retrospective Study On Perioperative Bacterial Infection And Immunosuppressive Regimen In Liver Transplant Recipients

Objective: To investigate the risk factors of perioperative bacterial infection(BIs,Bacterial Infections)in liver transplantation(LT,Liver Transplantation)recipients and the effect of bacterial infection on the survival of liver transplant recipients.The postoperative biochemical indexes of patients with bacterial infection and those without bacterial infection were compared.To analyze the changes of blood valley concentration of immunosuppressant tacrolimus(FK506,Tacrolimus)during peri-operation of liver transplantation and to find out the safe range of use.Methods: A retrospective study was conducted on 59 recipients who underwent cardiac death organ donation(DCD,Donation after Cardiac Death)liver transplantation in the Department of Hepatobiliary surgery of the first affiliated Hospital of Chongqing Medical University from January2013 to December 2019.The results of etiological examination within 14 days after liver transplantation and the blood valley concentration of tacrolimus on the 5th,7th and 14 th day after operation were counted.(2)Sex,age,indication of liver transplantation,preoperative end-stage liverdisease(MELD,Model for End-stage Liver Disease)score,postoperative respiratory support time,postoperative intensive care unit(ICU,Intensive care unit)retention time,parenteral nutrition time,postoperative biochemical index,hospitalization days.(3)follow up the survival status of the recipients within 1 year after operation.Independent sample t-test or Mann-Whitney U test was used to compare the differences of influencing factors between infected and non-infected patients after operation.repeated measurement analysis of variance was used to compare the differences of postoperative data between infected group and non-infected group.Logistic regression analysis was used to analyze high risk factors,which were expressed by odds ratio(OR)and 95% confidence interval(95%CI).According to the results of univariate Logistic regression analysis,the factors of P < 0.05 were included in the Logistic regression equation for multivariate analysis.Kaplan-meier method was used to analyze the effect of infection on long-term survival of patients.Results: The independent risk factors of bacterial infection after early transplantation included long postoperative respiratory support time(OR,1.076;95% confidence interval,1.013-1.144 × ICU 0.018)and long ICU indwelling time(OR,1.019;95% confidence interval,1.001-1.036 × PP0.038).Survival analysis showed that there was no significant difference in1-year cumulative survival rate between postoperative infected and uninfected patients(Purge 0.698).On the fifth day after operation,the areaunder the ROC curve of tacrolimus blood concentration(AUC)was 0.737(P < 0.05,sensitivity was 83.3%,specificity was 83%),and the cut-off value of tacrolimus blood concentration was 6.85ng/ml.Conclusion: The main pathogen of infection in liver transplant recipients is Acinetobacter baumannii(AB,Acinetobacter baumannii).In order to reduce the incidence of early bacterial infection in liver transplant recipients,the postoperative respiratory support time and ICU retention time should be reduced as much as possible.the blood trough concentration of tacrolimus is below 6.85ng/ml for the first time after liver transplantation,which may reduce the incidence of bacterial infection.