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Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant

Philip G Ferstl1, Natalie Filmann2, Eva-Maria Heilgenthal1

  • 1Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany.

Plos One
|January 22, 2021
PubMed
Abstract

Insights

Multidrug-resistant organism (MDRO) colonization increases mortality risk for liver transplant candidates on the waiting list. However, MDRO colonization did not significantly impact short-term survival post-liver transplant, though carbapenem-resistant gram-negative bacteria pose a high risk.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Transplantation Medicine

Background:

  • Rising prevalence of multidrug-resistant organisms (MDRO) presents a significant challenge in patients with liver cirrhosis.
  • The specific impact of MDRO colonization on mortality in liver transplantation (LT) candidates and recipients requires detailed investigation.

Purpose of the Study:

  • To determine the impact of MDRO colonization on mortality in liver transplant candidates and recipients.
  • To analyze the incidence and outcomes of MDRO colonization during the LT waiting period and post-transplant.

Main Methods:

  • Screening for MDRO colonization (MRSA, MDRGN, VRE) in 351 LT candidates from 2008-2018.
  • Monitoring colonization status at LT evaluation, during hospitalizations, and post-transplant.
  • Analyzing mortality rates associated with MDRO colonization.

Main Results:

  • MDRO colonization incidence increased during the LT waiting time.
  • MDRO colonization was significantly associated with increased mortality on the waiting list (HR = 2.57, p<0.0001).
  • Colonization with carbapenem-resistant gram-negative bacteria (CRGN) was associated with high mortality in 10 out of 14 affected patients.

Conclusions:

  • MDRO colonization is linked to higher mortality risk for patients awaiting liver transplantation.
  • Short-term survival after liver transplant is not significantly affected by MDRO colonization.
  • Carbapenem-resistant gram-negative bacteria colonization appears to be a critical factor for high mortality in liver transplant candidates and recipients.

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