[Prevalence and risk factors for early postoperative infection after liver transplantation]

Area of Science:

• Hepatology
• Transplant Surgery
• Infectious Diseases

Background:

• Post-liver transplant infection remains a significant challenge, impacting patient outcomes.
• Identifying early infection risk factors is crucial for timely intervention and improved graft survival.

Purpose of the Study:

• To analyze pre-, intra-, and postoperative factors associated with the early development of infection following liver transplantation.
• To identify significant risk factors for post-transplant infection through multivariate analysis.

Main Methods:

• Retrospective analysis of 1000 adult liver transplant cases performed between 1991 and 2004.
• Comparison of recipient variables between patients who developed infection and those who did not.
• Multivariate analysis to determine independent risk factors for infection.

Main Results:

• Infection occurred in 151 patients, with bacterial infections being most common.
• Significant risk factors included: male sex, Child-Pugh stage, hepatitis C virus cirrhosis, post-reperfusion syndrome, vena cava preservation technique, history of diabetes mellitus, respiratory distress syndrome, pulmonary edema, renal dysfunction, acute renal insufficiency, neurological alterations, postoperative bleeding, graft dysfunction, and primary graft failure.
• Factors like acute renal insufficiency (OR, 20.24) and respiratory distress syndrome (OR, 6.60) showed particularly high odds ratios for infection.

Conclusions:

• Infection is a persistent and difficult-to-control complication after liver transplantation.
• Modifiable risk factors such as renal dysfunction and pulmonary edema warrant careful management.
• Donor-recipient matching for initial graft dysfunction and understanding inherent risks like post-reperfusion syndrome are important.
• Immunosuppression is a critical mediator of infection development and clinical presentation post-transplant.