Risk stratification for early bacteremia after living donor liver transplantation: a retrospective observational cohort study

Abstract

Background: This study investigated perioperative clinical risk factors for early post-transplant bacteremia in patients undergoing living donor liver transplantation (LDLT). Additionally, postoperative outcomes were compared between patients with and without early post-transplant bacteremia. Methods: Clinical data of 610 adult patients who underwent elective LDLT between January 2009 and December 2018 at Seoul St. Mary's Hospital were retrospectively collected. The exclusion criteria included overt signs of infection within 1 month before surgery. A total of 596 adult patients were enrolled in this study. Based on the occurrence of a systemic bacterial infection after surgery, patients were classified into non-infected and infected groups. Results: The incidence of bacteremia at 1 month after LDLT was 9.7% (57 patients) and Enterococcus faecium (31.6%) was the most commonly cultured bacterium in the blood samples. Univariate analysis showed that preoperative psoas muscle index (PMI), model for end-stage disease score, utility of continuous renal replacement therapy (CRRT), ascites, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, and sodium level, as well as intraoperative post-reperfusion syndrome, mean central venous pressure, requirement for packed red blood cells and fresh frozen plasma, hourly fluid infusion and urine output, and short-term postoperative early allograft dysfunction (EAD) were associated with the risk of early post-transplant bacteremia. Multivariate analysis revealed that PMI, the CRRT requirement, the NLR, and EAD were independently associated with the risk of early post-transplant bacteremia (area under the curve: 0.707; 95% confidence interval: 0.667-0.745; p < 0.001). The overall survival rate was better in the non-infected patient group. Among patients with bacteremia, anti-bacterial treatment was unable to resolve infection in 34 patients, resulting in an increased risk of patient mortality. Among the factors included in the model, EAD was significantly correlated with non-resolving infection. Conclusions: We propose a prognostic model to identify patients at high risk for a bloodstream bacterial infection; furthermore, our findings support the notion that skeletal muscle depletion, CRRT requirement, systemic inflammatory response, and delayed liver graft function are associated with a pathogenic vulnerability in cirrhotic patients who undergo LDLT.

In-hospital mortality of liver transplantation and risk factors: a single-center experience

“…In some studies, infection was confirmed as the main cause for both short-and long-term death (20). Park et al (21) reported that 57 (9.7%) recipients who underwent living donor LT experienced infection within 1 month after surgery and 34 recipients lost their lives due to infection, and the incidence of infectious death was 5.7% (34/596). A study designed by Kwak et al (17) demonstrated that pneumonia, which occurred in 46.3% of patients, was the most common cause of all infectious deaths.…”

Clinical and hematological characteristics of 88 patients with COVID‐19

“…Based on changes in the CBC after disease onset, the NLR has a good ability to differentiate patients who will become critical within 4 weeks after disease onset. The NLR is the ratio of neutrophils to lymphocytes in peripheral blood, and its clinical value in infectious diseases or inflammation has been gradually appreciated 22,23,24 . In the early stage of this epidemic, a study carried out by Beijing Ditan Hospital Affiliated to Capital Medical University 25 showed that if a patient had an NLR > 3.13 and was over 50 years old, he/she was more likely to develop severe disease, and intensive care should be considered as early as possible.…”

“…The NLR is the ratio of neutrophils to lymphocytes in peripheral blood, and its clinical value in infectious diseases or inflammation has been gradually appreciated. 22,23,24 In the early stage of this epidemic, a study carried out by Beijing Ditan Hospital Affiliated to Capital Medical University 25 showed that if a patient had an NLR > 3.13 and was over 50 years old, he/she was more likely to develop severe disease, and intensive care should be considered as early as possible. This study also found that the NLR had a better differentiation value than other parameters for identi- invaded by the pathogen.…”

Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: A propensity score-matching analysis

“…Donor-graft findings included age, sex, BMI, graft-to-recipient weight ratio, total ischemic time, fatty change, and hepatic vascular circulation. Postoperatively, we measured glucose levels from the first postoperative day for 1−4 weeks after surgery; early bacteremia status (during the first 4 weeks after surgery) [ 22 ]; and new-onset DM developing during the follow-up period [ 23 ].…”