A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation

Abstract

Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. Methods: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. Results: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum b-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (487 minutes) and differences in body mass index between donor and recipient (1.3 kg/m 2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia 175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). Conclusions: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant

“…Infections with MDRO are associated with increased mortality, meaning that early recognition is crucial. 15 Some risk factors identified in the lung transplant population were similar to those found in other transplant populations, such as patients receiving a kidney or liver transplant [16][17][18] and included higher BMI, which could increase the risk for SSI by up to 1.3 times. 19 Likewise, prolonged surgery time was also a risk factor for SSIs in other studies of pulmonary surgeries, 3,8,20 possibly due to the complexity of the surgery performed.…”

Perioperative intensive glycemic control for liver transplant recipients to prevent surgical site infection: A systematic review and meta‐analysis

“…7 Around 26% of patients having a liver transplant develop an SSI. 8 The risk of death or graft loss is more than doubled for transplant patients who have an SSI, as well as having longer lengths of stay, higher re-admission rates and increased use of healthcare resources. 7,9,10 It is therefore worth identifying and addressing the factors which cause SSIs in order to reduce SSIs among transplant patients.…”

“…These are multifactorial and are conventionally categorized into those arising from donors, recipients, or the surgical team, those relating to the surgery, or those relating to the anesthetic. 8,11,12 One of the SSI risk factors, hyperglycemia, is a particular concern for liver transplant patients. Hyperglycemia is common among diabetic and non-diabetic patients in the intraoperative and intensive care periods following transplantation, with an incidence ranging from 20.8% to 62.3%.…”

“…Hyperglycemia is common among diabetic and non-diabetic patients in the intraoperative and intensive care periods following transplantation, with an incidence ranging from 20.8% to 62.3%. 8,[13][14][15] It occurs as a result of surgical stress, which decreases pancreatic functions, resulting in lower plasma insulin levels. This hypoinsulinemia, combined with insulin resistance and excessive catabolism due to the action of counter-regulatory hormones, commonly leads to hyperglycemia.…”

“…This is because, for example, liver transplant recipients have high levels of immunosuppression which start during the intraoperative period, they have longer than standard surgery times (up to around 8 hours), 8 and high rates of hyperglycemia caused by the administration of catecholamine's to prevent hypovolemic shock. 8,15 Some studies of intensive glycemic control among liver transplant recipients to prevent SSIs exist, although they have found contradictory results. 21,22,33 Therefore, the primary objective of this review is to determine if intensive glycemic control, compared with standard glycemic control, is more effective in reducing SSIs among liver transplant recipients.…”