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Journal of Clinical and Experimental Hepatology logoLink to Journal of Clinical and Experimental Hepatology
. 2012 Apr 12;2(1):35–41. doi: 10.1016/S0973-6883(12)60081-4

Perioperative Bacterial Infections in Deceased Donor and Living Donor Liver Transplant Recipients

Joy Varghese *,*, Narasimhan Gomathy **, Perumalla Rajashekhar **, Kota Venugopal **, Arikichenin Olithselvan *, Shanmugam Vivekanandan **, Shanmugam Naresh *, Chandrasekaran Sujatha †, Srinivasan Vijaya *, Venkataraman Jayanthi *, Mohamed Rela *,**
PMCID: PMC3940144  PMID: 25755404

Abstract

Background

Deceased donor (DDLT) and living donor (LDLT) liver transplant (LT) is in vogue in several centers in India. Most centers are resorting to LDLT as a preferred surgery due to shortage of deceased donor liver. The risk of infection and its effect on survival in both groups of recipients from the Indian subcontinent are not known. The study was conducted to compare the bacterial infection rates among LDLT and DDLT recipients and their impact on survival at a tertiary referral center.

Methods

Retrospective data on 67 LT recipients were reviewed. Data on pre-, per-, and postoperative bacterial infection rates and the common isolates were obtained.

Results

Thirty-five patients had LDLT and 32 had DDLT. The prevalence of pre-operative bacterial infection and the isolates was similar in both groups. The perioperative bacterial infection rates were significantly higher in DDLT recipients (P < 0.01) (relative risk: 1.44 95% confidence interval 1.04–1.9). In both LDLT and DDLT, the common source was urinary tract followed by bloodstream infection. The common bacterial isolates in either transplant were Klebsiella followed by Escherichia coli, Pseudomonas spp. and nonfermenting gram-negative bacteria. Six patients (four LDLT; two DDLT) were treated for tuberculosis. Among the risk factors, cold ischemic time, and duration of stay in the intensive care unit was significantly higher for DDLT (p < 0.01). The death rates were not significantly different in the two groups. However, the odds for death were significantly high at 26.8 (p < 0.05) for postoperative bacterial infection and 1.8 (p < 0.001) for past alcohol.

Conclusion

Liver transplant recipients are at high-risk for bacterial infection irrespective of type of transplant, more so in DDLT.

Keywords: Bacteria, infection, liver transplant

Abbreviations: AFB, acid fast bacilli; ATT, anti-tuberculous treatment; BAL, bronchoalveolar lavage; BSI, bloodstream infections; CIT, cold ischemic time; CLSI, Clinical and Laboratory Standards Institute; CRP, C-reactive protein; DDLT, deceased donor liver transplant; E. coli, Escherichia coli; ET, endotracheal; ICU, intensive care unit; K. pneumonia, Klebsiella pneumonia; LDLT, living donor liver transplant; LT, liver transplant; MELD, model for end-stage liver disease; MRSA, methicillin-resistant Staphylococcus aureus; NFGNB, nonfermenting gram-negative bacilli; P. aeruginosa, Pseudomonas aeruginosa; RFA, radiofrequency ablation; RR, relative risk; TACE, transarterial chemoembolization; TB, tuberculosis

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References

  • 1.Jha V, Chugh KS. Post transplant infections in the tropical countries. Artif Organs. 2002;26:770–777. doi: 10.1046/j.1525-1594.2002.07069.x. [DOI] [PubMed] [Google Scholar]
  • 2.George B, Mathews V, Srivastawa A, Chandy M. Infections among allogeniec bone marrow recipients in India. Bone Marrow Transplant. 2004;33:311–315. doi: 10.1038/sj.bmt.1704347. [DOI] [PubMed] [Google Scholar]
  • 3.Fishman JA. Infection in solid organ transplant recipients. NEJM. 2007;357:2601–2614. doi: 10.1056/NEJMra064928. [DOI] [PubMed] [Google Scholar]
  • 4.Collins LA, Samore MH, Roberts MS. Risk factors for invasive fungal infections complicating orthotopic liver transplantation. J Infect Dis. 1994;170:644–652. [PubMed] [Google Scholar]
  • 5.Castalo P, Stratta RJ, Wood RP. Clinical spectrum of fungal infections after orthotopic liver transplantation. Arch Surg. 1991;126:149–156. doi: 10.1001/archsurg.1991.01410260033005. [DOI] [PubMed] [Google Scholar]
  • 6.Gladdy RA, Richardson SE, Davies SE. Candida infection in pediatric liver transplant recipients. Liver Transpl Surg. 1999;5:16–24. doi: 10.1002/lt.500050105. [DOI] [PubMed] [Google Scholar]
  • 7.Kusne S, Dummer JS, Singh N. Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine (Baltimore) 1988;67:132–143. doi: 10.1097/00005792-198803000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Kanj SS, Sharara AI, Calvien PA. Cytomegalic virus infection following liver transplantation: review of literature. Clin Infect Dis. 1996;22:537–549. doi: 10.1093/clinids/22.3.537. [DOI] [PubMed] [Google Scholar]
  • 9.Principles and Procedures for Blood cultures-Approved guidelines. Clinical Laboratory Standards Institute, January 2007. Doc.M47
  • 10.Torbenson M, Wang J, Nichols L. Causes of death in autopsied liver transplantation patients. Mod Pathol. 1998;11:37–46. [PubMed] [Google Scholar]
  • 11.Winston DJ, Emmanouilides C, Busuttil RW. Infections in liver transplant recipients. Clin Infect Dis. 1995;21:1077–1089. doi: 10.1093/clinids/21.5.1077. [DOI] [PubMed] [Google Scholar]
  • 12.Colona JO, Winston DJ, Brill JE. Infectious complications in liver transplantation. Arch Surg. 1988;123:360–364. doi: 10.1001/archsurg.1988.01400270094015. [DOI] [PubMed] [Google Scholar]
  • 13.Kim YJ, Kim SI, Wie SH. Infectious complications in living donor liver transplant recipients: 9-year single center experience. Transpl Infect Dis. 2008;10:316–324. doi: 10.1111/j.1399-3062.2008.00315.x. [DOI] [PubMed] [Google Scholar]
  • 14.Singh N, Wagner MM, Gayowski T. Seasonal pattern of early mortality and infectious complications in liver transplant recipients. Liver Transpl. 2001;7:884–889. doi: 10.1053/jlts.2001.27864. [DOI] [PubMed] [Google Scholar]
  • 15.Fishman JA, Rubin RH. Infection in organ-transplant recipients. NEJM. 1998;338:1741–1751. doi: 10.1056/NEJM199806113382407. [DOI] [PubMed] [Google Scholar]
  • 16.Singh N, Wagener MM, Obaman A. Bacteremias in liver transplant recipients: shift toward gram negative bacteria as predominant pathogens. Liver Transpl. 2004;10:844–849. doi: 10.1002/lt.20214. [DOI] [PubMed] [Google Scholar]
  • 17.Hashimoto A, Hashimoto M, Sugawara Y. Bloodstream infection after living donor liver transplantation. Scand J Infect Dis. 2008;40:509–516. doi: 10.1080/00365540701824116. [DOI] [PubMed] [Google Scholar]
  • 18.Hashimoto M, Sugawara Y, Tamura S. Acquisition of methicillin-resistant Staphylococcus aureus after living donor liver transplantation: a retrospective cohort study. BMC Infect Dis. 2008;11:155. doi: 10.1186/1471-2334-8-155. (Abstract). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Hashimoto A, Hashimoto M, Sugawars Y. Impact of new methicillin-resistant Staphylococcus aureus carriage postoperatively after living donor liver transplantation. Transplant Proc. 2007;39:3271–3275. doi: 10.1016/j.transproceed.2007.09.035. [DOI] [PubMed] [Google Scholar]
  • 20.Kim BS, Lee SG, Hwang S. Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation. Transplant Proc. 2009;41:250–252. doi: 10.1016/j.transproceed.2008.10.033. [DOI] [PubMed] [Google Scholar]
  • 21.Kim YJ, Yoon JH, Kim SI. High mortality associated with acinetobacter species infection in liver transplant patients. Transplant Proc. 2011;43:2397–2399. doi: 10.1016/j.transproceed.2011.06.011. [DOI] [PubMed] [Google Scholar]
  • 22.Holty JE, Gould MK, Meinke L. Tuberculosis in liver transplant recipients: a systematic review and meta-analysis of individual patient data. Liver Transpl. 2009;15:894–906. doi: 10.1002/lt.21709. [DOI] [PubMed] [Google Scholar]
  • 23.Jahng AW, Tran T, Bui L. Safety of treatment of latent tuberculosis infection in compensated cirrhotic patients during candidacy period. Transplantation. 2007;83:1557–1562. doi: 10.1097/01.tp.0000266578.45634.4f. [DOI] [PubMed] [Google Scholar]
  • 24.Subramanian N, Dorman S, AST Infectious Disease Community of Practice Mycobacterium tuberculosis in solid organ transplant recipients. Am J Transplant. 2009;9(Suppl 4):S57–S62. doi: 10.1111/j.1600-6143.2009.02894.x. [DOI] [PubMed] [Google Scholar]
  • 25.Singh N, Wagener MM, Gayowski T. Safety and efficacy of isoniazid chemoprophylaxis administered during liver transplant candidacy for the prevention of post-transplant tuberculosis. Transplantation. 2002;74:892–895. doi: 10.1097/01.TP.0000027945.73198.66. [DOI] [PubMed] [Google Scholar]
  • 26.Chan AC, Lo CM, Ng KK. Implications for management of Mycobacterium tuberculosis infection in adult-to-adult live donor liver transplantation. Liver Int. 2007;27:81–85. doi: 10.1111/j.1478-3231.2006.01397.x. [DOI] [PubMed] [Google Scholar]

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