Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University...

Area of Science:

• Transplant Surgery
• Infectious Diseases
• Surgical Outcomes

Background:

• Invasive primary surgical site infections (IP-SSI) are a serious complication following liver transplant surgery.
• Identifying risk factors is crucial for developing effective IP-SSI prevention strategies.

Purpose of the Study:

• To identify risk factors associated with invasive primary surgical site infections (IP-SSI) in adult liver transplant recipients.
• To analyze the impact of IP-SSI on patient outcomes, including hospitalization duration and mortality.

Main Methods:

• Retrospective review of adult single liver transplants performed between 2015-2020.
• Utilized least absolute shrinkage and selection operator (LASSO) for variable selection to identify risk factors.
• Statistical significance was determined with a 2-sided P value <0.05.

Main Results:

• IP-SSI occurred in 7.2% of transplants (34/470).
• Risk factors included repeat transplantation, split liver, Roux-en-Y biliary anastomosis, anastomotic leak, and post-transplant renal replacement therapy.
• IP-SSI significantly increased hospitalization length (24.5 vs 10.0 days) and 1-year mortality (14.7% vs 4.1%). Gram-positive bacteria were the most common pathogens, with a notable increase in multidrug-resistant bacteria over time.

Conclusions:

• Surgical factors, rather than antimicrobial prophylaxis, were the primary drivers of IP-SSI in this cohort.
• IP-SSI negatively impacts hospitalization duration and 1-year mortality.
• While modifiable surgical factors are limited, close clinical monitoring and tailored antimicrobial therapy are key to managing IP-SSI risk.