Severe Sepsis After Living Donor Liver Transplantation: Risk Factors and Outcomes

Area of Science:

• Transplantation Surgery
• Infectious Disease Epidemiology
• Immunology

Background:

• Living-donor liver transplantation (LDLT) has high post-operative mortality and morbidity.
• Risk factors for post-operative infectious complications in LDLT are known, but less is understood about factors influencing sepsis severity.

Purpose of the Study:

• To identify risk factors associated with severe sepsis following LDLT.
• To analyze peri-operative characteristics differentiating patients who develop sepsis from those who do not.

Main Methods:

• A comparative study of 63 LDLT patients, divided into sepsis (n=13) and severe sepsis (n=16) groups, and a control group without sepsis (n=34).
• Multivariate analysis was used to determine significant peri-operative risk factors for sepsis and severe sepsis.

Main Results:

• ABO incompatibility, low estimated glomerular filtration rates, and low pre-operative lymphocyte counts (<850/μL) were risk factors for post-operative sepsis.
• A low pre-operative lymphocyte count (<850/μL) was the sole significant risk factor for severe sepsis.
• Severe sepsis patients had significantly lower 5- and 10-year survival rates (37.5%) compared to sepsis patients (83.3% and 62.5%).
• The lung was the most frequent site of severe sepsis (50.0%).

Conclusions:

• Patients experiencing severe sepsis post-LDLT exhibit poor long-term survival.
• Pre-operative lymphocyte count <850/μL is a critical predictor of severe sepsis.
• Pre-operative nutritional intervention and rehabilitation may improve outcomes in LDLT recipients.