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Perfusion fluid-related infections in liver transplant recipients: A 5-year, single-center, retrospective study
Andrea Lombardi1,2, Giulia Renisi1, Daniele Dondossola2,3
1Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy.
Background:
Perfusion fluid (PRF) is employed in liver transplantation (LTx) to maintain graft viability. Still, it represents a new potential way of infection transmission in LTx recipients (LTRs). Currently, no systematic research has investigated this topic.
Methods:
Five-year single-center retrospective study conducted on LTRs from January 2017 to December 2021. We analyzed the incidence of positive PRF culture (PRF+) and perfusion fluid-related infections (PRF-RI) and their associated factors. We also assessed 1-year mortality, both overall and infection-related.
Results:
Overall, 234 LTx were included. PRF+ were found in 31/234 (13.2%) LTx for a total of 37 isolates, with >1 isolate identified in 5 (2.1%) cases. High-risk microorganisms (Enterobacterales 13/37, Enterococcus spp. 4/37, S. aureus 3/37, P. aeruginosa 2/37) were isolated in 25/37 (67.6%) LTRs, the remaining being coagulase-negative staphylococci (12/37, 32.4%). Antimicrobial prophylaxis was administered to all LTRs, always active against the isolate even if suboptimal in 19 cases (61.3%). PRF-RI developed in 4/234 LTx (1.7%), and prophylaxis was considered suboptimal in 2/4 of them. The isolation of >1 microorganism in PRF culture was associated with an increased risk of developing PRF-RI (OR 37.5 [95%CI 2.6-548.4], p = .01). PRF-RI were associated with longer ICU stays (p = .005) and higher 1-year mortality, both overall and related to infections (p = .001).
Conclusion:
Despite PRF+ being infrequent, only a minority of patients develops PRF-RI. Nonetheless, once occurred, PRF-RI seems to increase morbidity and mortality rates.
Insights
Perfusion fluid (PRF) in liver transplantation (LTx) can transmit infections to recipients (LTRs). While rare, PRF-related infections (PRF-RI) significantly increase LTR mortality and morbidity.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Organ Preservation
Background:
- Perfusion fluid (PRF) is crucial for maintaining liver graft viability during liver transplantation (LTx).
- PRF may serve as a potential route for transmitting infections to liver transplant recipients (LTRs).
- Limited systematic research exists on PRF as an infection source in LTx.
Purpose of the Study:
- To investigate the incidence of positive PRF cultures (PRF+) and PRF-related infections (PRF-RI) in LTRs.
- To identify factors associated with PRF+ and PRF-RI.
- To assess the impact of PRF-RI on LTR outcomes, including 1-year mortality.
Main Methods:
- A 5-year single-center retrospective study (January 2017 - December 2021) included 234 LTRs.
- Analysis of PRF culture results, PRF-RI incidence, and associated risk factors.
- Evaluation of 1-year overall and infection-related mortality.
Main Results:
- Positive PRF cultures (PRF+) occurred in 13.2% of LTx, with high-risk microorganisms identified in 67.6% of cases.
- Perfusion fluid-related infections (PRF-RI) developed in 1.7% of LTRs.
- Isolation of multiple microorganisms in PRF culture significantly increased PRF-RI risk (OR 37.5, p = .01). PRF-RI were linked to longer ICU stays and higher 1-year mortality (p = .001).
Conclusions:
- Although PRF+ is uncommon, PRF-RI develops in a small proportion of LTRs.
- PRF-RI is associated with increased morbidity and mortality following liver transplantation.
- Vigilance for PRF contamination is warranted to mitigate potential adverse outcomes in LTRs.
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