Multidrug-Resistant Bacteria and Disease Progression in Patients with End-Stage Liver Disease and after Liver
Kilian Friedrich1, Jessica Krempl2, Shigehiko Schamoni3
1Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany. . kilianfriedrich@gmx.de.
Background:
Multidrug-resistant (MDR) pathogens represent an emerging challenge in end-stage liver disease and in liver transplant recipients.
Methods:
We evaluated the impact of MDR bacteria upon clinical outcomes in patients with end-stage liver disease (n = 777) at the time of enrollment on the liver transplant (LTx) waiting list, after first LTx (n = 645), and after second LTx (n = 128).
Results:
Colonization/infection with MDR bacteria was present in 72/777 patients on the waiting list, in 98/645 patients at first LTx, and in 46/128 patients at second LTx. While on the LTx waiting list, the time until first hydropic decompensation (p = 0.021), hepatic encephalopathy (p < 0.001) and hepatorenal syndrome (p < 0.001) was reduced in the presence of MDR bacteria, which remained an independent risk factor of poor survival in multivariate analysis (p < 0.001). Following first and second liver transplant, MDR bacteria were associated with an increased risk of infection-related deaths (first LTx: p < 0.001; second LTx: p = 0.037) and reduced actuarial survival (first LTx: p < 0.001; second LTx: p = 0.046).
Conclusions:
We showed that MDR pathogens are associated with poor outcomes before, after first and after recurrent LTx.
Insights
Multidrug-resistant (MDR) pathogens negatively impact patients with end-stage liver disease awaiting liver transplant (LTx) and those who have undergone LTx. MDR bacteria are linked to worse survival and increased complications in these vulnerable patient populations.
Area of Science:
- Hepatology
- Infectious Diseases
- Transplantation Medicine
Background:
- Multidrug-resistant (MDR) pathogens pose a growing threat to patients with end-stage liver disease (ESLD).
- These resistant organisms present significant challenges for liver transplant (LTx) recipients.
Purpose of the Study:
- To investigate the clinical impact of MDR bacteria on patient outcomes.
- To assess the association between MDR pathogens and survival in ESLD patients before and after LTx.
Main Methods:
- A retrospective study evaluated 777 patients on the LTx waiting list, 645 after first LTx, and 128 after second LTx.
- Clinical outcomes, including decompensation events and survival rates, were analyzed in relation to MDR bacterial colonization or infection.
Main Results:
- MDR bacteria were present in a significant proportion of patients across all groups (waiting list, first LTx, second LTx).
- On the LTx waiting list, MDR bacteria were associated with reduced time to decompensation events and were an independent risk factor for poor survival.
- Following LTx (first and second), MDR bacteria increased the risk of infection-related deaths and reduced actuarial survival.
Conclusions:
- MDR pathogens are associated with adverse outcomes in patients with ESLD.
- The presence of MDR bacteria significantly worsens prognosis both before and after liver transplantation.
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