Multidrug-Resistant Bacteria and Disease Progression in Patients with End-Stage Liver Disease and after Liver Transplantation

Abstract

Background: Multidrug-resistant (MDR) pathogens represent an emerging challenge in end-stage liver disease and in liver transplant recipients.
 Methods: We evaluated the impact of MDR bacteria upon clinical outcomes in patients with end-stage liver disease (n = 777) at the time of enrollment on the liver transplant (LTx) waiting list, after first LTx (n = 645), and after second LTx (n = 128).
 Results: Colonization/infection with MDR bacteria was present in 72/777 patients on the waiting list, in 98/645 patients at first LTx, and in 46/128 patients at second LTx. While on the LTx waiting list, the time until first hydropic decompensation (p = 0.021), hepatic encephalopathy (p < 0.001) and hepatorenal syndrome (p < 0.001) was reduced in the presence of MDR bacteria, which remained an independent risk factor of poor survival in multivariate analysis (p < 0.001). Following first and second liver transplant, MDR bacteria were associated with an increased risk of infection-related deaths (first LTx: p < 0.001; second LTx: p = 0.037) and reduced actuarial survival (first LTx: p < 0.001; second LTx: p = 0.046).
 Conclusions: We showed that MDR pathogens are associated with poor outcomes before, after first and after recurrent LTx.

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

“…A multicenter study in the US [28] clearly showed that the risk of being delisted from the LT waiting list within six months was much higher in infected patients with cirrhosis (42%) than in non-infected wait-listed patients, even in the case where a sub-analysis on MDRO strains was not yet reported. Moreover, a recent study on the Eurotransplant database by Friedrich et al [29] showed that twenty-three LT candidates with pre-LT MDRO infection had significantly higher chances of being delisted from the waiting list than patients without infection, since the occurrence of MDRO infection led to a two-fold mortality risk while awaiting transplantation. In the above-mentioned study conducted at our center [27], we demonstrated that for patients in the waiting list for LT, BI was an independent predictor of mortality, but patients who recovered from BI and readmitted to the waiting list after thirty days had a good probability of receiving LT, and their mortality risk was similar to patients without infection.…”

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study

“…The significance of colonization with multidrug-resistant pathogens is often not unequivocally elucidated in many instances. For example, the state of research among liver transplant recipients remains inconclusive, and the impact on post-transplant survival varies across different studies [ 33 , 34 ]. However, our analyses did not demonstrate any influence of multidrug-resistant bacterial colonization on the infection rate after ERCP procedures.…”

Association of iron overload with infectious complications in liver transplant recipients: a systematic review and meta-analysis

“…Infection caused by bacteria, fungi, and viruses remains one of the leading causes of morbidity and mortality among transplant recipients worldwide. [1][2][3] Knowledge of modifiable risk factors and their potentially reversible causes is essential to develop targeted preventive strategies.…”