Poor outcomes of early recurrent post-transplant bloodstream infection in living-donor liver transplant recipients.
Si-Ho KimSeok Jun MunJae-Hoon KoKyungmin HuhSun Young ChoCheol-In KangDoo Ryeon ChungGyu-Seong ChoiJong Man KimJae-Won JohKyong-Ran PeckPublished in: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2020)
Bloodstream infection (BSI) is a common complication after living-donor liver transplantation (LDLT). Some patients develop recurrent BSIs. We evaluated the impacts of early recurrent BSIs (ER-BSIs) on outcomes in LDLT recipients. LDLT cases between 2008 and 2016 were included. Early BSI (E-BSI) was defined as a BSI event that occurred within 2 months after LDLT. ER-BSIs were defined as new-onset BSIs within 2 months due to another pathogen at a ≥ 48-h interval or a relapse of BSIs by the same pathogen at a ≥ 1-week interval, with negative cultures in between. The primary objective was evaluating the all-cause mortality of each group of LDLT recipients (90 days and 1 year). The secondary objectives were analyzing associated factors of each all-cause mortality and risk factors for early single BSI and ER-BSI. Among 727 LDLT recipients, 108 patients experienced 149 events of E-BSI with 170 isolated pathogens. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. The 1-year survival rates of patients without BSI, with early single BSI event, and with ER-BSIs were 92.4%, 81.3%, and 28.6%, respectively. ER-BSI was the most significant risk factor for 1-year mortality (adjusted HR = 5.31; 95% CI = 2.27-12.40). Intra-abdominal and/or biliary complications and early allograft dysfunction were risk factors for both early single BSI and ER-BSI. Interestingly, longer cold ischemic time and recipient operative time were associated with ER-BSI. LDLT recipients with ER-BSI showed very low survival rates accompanied by intra-abdominal complications. Clinicians should prevent BSI recurrence by being aware of intra-abdominal complications.
Keyphrases
- end stage renal disease
- ejection fraction
- newly diagnosed
- estrogen receptor
- endoplasmic reticulum
- chronic kidney disease
- peritoneal dialysis
- clinical trial
- type diabetes
- prognostic factors
- risk factors
- cardiovascular disease
- breast cancer cells
- randomized controlled trial
- metabolic syndrome
- brain injury
- coronary artery disease
- cardiovascular events
- free survival
- oxidative stress
- klebsiella pneumoniae
- insulin resistance
- multidrug resistant
- study protocol