Impact of preoperative infection on outcome after liver transplantation

• Published in: British journal of surgery Vol. 104; no. 2; pp. e172 - e181
• Main Authors: Bertuzzo, V. R., Giannella, M., Cucchetti, A., Pinna, A. D., Grossi, A., Ravaioli, M., Del Gaudio, M., Cristini, F., Viale, P., Cescon, M.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2017; Oxford University Press
• Subjects: Acute-On-Chronic Liver Failure - surgery; Adolescent; Adult; Aged; Bacterial infections; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Female; Humans; Infections; Italy - epidemiology; Liver; Liver Transplantation - mortality; Liver transplants; Male; Middle Aged; Mortality; Multivariate Analysis; Postoperative Complications; Preoperative Period; Reoperation; Retrospective Studies; Severity of Illness Index; Transplants & implants; Young Adult
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.10449

Background Bacterial infection in patients with liver failure can lead to a dramatic clinical deterioration. The indications for liver transplantation and outcome in these patients is still controversial. Methods All adult patients who underwent liver transplantation between 1 January 2010 and 31 December 2015 were selected from an institutional database. Characteristics of the donors and recipients, and clinical, biochemical and surgical parameters were retrieved from the database. Post‐transplant survival rates and complications, including grade III–IV complications according to the Dindo–Clavien classification, were compared between patients with an infection 1 month before transplantation and patients without an infection. Results Eighty‐four patients with an infection had statistically significant higher Model for End‐stage Liver Disease (MELD), D‐MELD and Balance of Risk (BAR) scores and a higher rate of acute‐on‐chronic liver failure compared with findings in 343 patients with no infection. The rate of infection after liver transplantation was higher in patients who had an infection before the operation: 48 per cent versus 30·6 per cent in those with no infection before transplantation (P = 0·003). The percentage of patients with a postoperative complication (42 versus 40·5 per cent respectively; P = 0·849) and the 90‐day mortality rate (8 versus 6·4 per cent; P = 0·531) was no different between the groups. Multivariable analysis showed that a BAR score greater than 18 and acute‐on‐chronic liver failure were independent predictors of 90‐day mortality. Conclusion Bacterial infection 1 month before liver transplantation is related to a higher rate of infection after transplantation, but does not lead to a worse outcome. No adverse outcomes