Surgical site infections after liver retransplantation: Incidence and risk factors

Abstract

Surgical site infections (SSIs) after liver transplantation (LT) are associated with an increased risk of graft loss and death. The incidence of SSIs after LT and their risk factors have been determined for first LT but not for second LT. The importance of reporting the incidence of SSIs risk-stratified by first LT versus second LT is not known. All patients undergoing second LT at a single institution between 2003 and 2011 (n 5 152) were reviewed. The Kaplan-Meier method was used to estimate the cumulative SSI incidence. Relative risks (RRs) and 95% confidence intervals (CIs) from Cox proportional hazards regression models were used to evaluate associations of potential risk factors with SSIs after second LT. Thirty-one patients developed SSIs (6 superficial SSIs, 1 deep SSI, and 24 organ/space SSIs). The cumulative incidence of SSIs 30 days after LT was 20.8% (95% CI 5 14%-27%), which was slightly but not significantly higher than the previously reported incidence of SSIs after first LT at our institution between 2003 and 2008 (16%, RR 5 1.32, 95% CI 5 0.90-1.93, P 5.16). Units of transfused red blood cells [RR (doubling) 5 1.38, 95% CI 5 1.02-1.86, P 5.04] and hepaticojejunostomy (RR 5 2.22, 95% CI 5 1.05-4.72, P 5.04) were the only factors associated with SSIs after second LT in single-variable analysis. The associations weakened in a multivariate analysis (P 5.07 and P 5.07, respectively), potentially because of the correlation of red blood cell transfusions and hepaticojejunostomy (P 5.08). In conclusion, the incidence of SSIs after second LT was slightly higher but not significantly different than the published incidence of SSIs (16%) after first LT at the same institution. Significant independent risk factors for SSIs after second LT were not identified. Risk stratification for retransplantation may not be necessary when the incidence of SSIs after LT is being reported. Liver Transpl 20:930-936, 2014. V C 2014 AASLD.Received December 13, 2013; accepted April 11, 2014.The operative site is the leading anatomic site of infections in recipients of liver transplantation (LT).1 Surgical site infections (SSIs), as defined by the Centers for Disease Control and Prevention, have been reported to follow 11% to 34% of LT procedures, 2-5 and they have been associated with an increased risk of graft loss and death.6 Risk factors associated with SSIs in these investigations have included pretransplant antibiotic therapy, pretransplant mechanical ventilation, intraoperative hyperglycemia, intraoperative administration of vasopressors, need for intraoperative red blood cell transfusions, surgeons, and operative times. 2,3,5,6 Feedback about benchmarked, risk-adjusted rates of SSIs to surgeons has been associated with declines in the rates of these infections in nontransplant surgeries.7-10 An appropriate risk adjustment of SSI incidence is required for the identification of modifiable factors that are associated with the development of SSIs and for the feedback of credible information to surgeons. Published reports of ...

Changes in Surgical Site Infections after Living Donor Liver Transplantation

“…Relative to these other studies, our study also involved a higher mean intraoperative red blood cell transfusion volume [ 9 , 16 ]. Furthermore, the MELD/PELD scores in our study were higher than those reported in previous studies [ 8 , 18 ]. These factors cannot be discounted as risk factors for SSI after LDLT because they affected most of the patients examined in this study.…”

Low rate of surgical site infections after liver transplantation: A 5‐year retrospective cohort study

“…Thus, the higher risk of SSI in these patients is not unexpected. 26 Similar to other studies, we found an increased risk of SSI with posttransplant procedures 9,16 and longer operative times as has been, 4,27,28 which likely reflects increased opportunity for wound contamination, increased inflammation, and delayed healing. There may be some variability in surgical techniques that can potentially influence the rate of SSI.…”

Rates and causative pathogens of surgical site infections attributed to liver transplant procedures and other hepatic, biliary, or pancreatic procedures, 2015‐2018

“…[4][5][6][7][8] The risk for SSI among liver transplant recipients is heightened by multiple factors, including underlying comorbidities, complex transplant procedures involving the biliary tract, multiple transfusions of packed red blood cells, prolonged operative time, and intense immunosuppression. [4][5][6][7][8][9][10][11][12][13][14] Limited data are available on LTP SSI rates, causal pathogens, and antimicrobial resistance, and most data available are from single centers. In these studies, SSI rates attributed to LTPs were reported to range from 8.8% to 37.8%, and the most common pathogens included Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus spp., Staphylococcus aureus, and Candida spp.…”