Colonization by Vancomycin-Resistant Enterococci in Liver Transplantation: Risk Factors and Survival Impact

Vancomycin-resistant enterococci (VRE) are multidrug-resistant microorganisms (MDRO) commonly isolated in liver transplant recipients and potentially associated with worse outcomes. We aimed to identify risk factors associated with VRE colonization in liver transplantation (LT) and its impact on posttransplant survival.

This is a retrospective cohort that included all adults who underwent LT between 2010 and 2022 at a tertiary-level hospital in São Paulo, Brazil. Multivariate analyses were performed using logistic regression for VRE colonization risk and Cox regression for 180-day survival.

A total of 1209 patients were included, 119 patients (9.8%) were colonized with VRE at LT, while 175 (14.5%) were colonized after LT, 77 (6.4%) patients developed VRE infection after LT. In the multivariate analysis, use of SBP prophylaxis, presence of acute-on-chronic liver failure, hepatitis B virus infection, ASA score, length of hospital stay and MELD score were all associated with VRE colonization before LT. For VRE colonization after LT, the predictors were length of hospital stay before LT, MELD score, carbapenem-resistant Gram-negative colonization, intraoperative bleeding and re-transplantation. Note that 180-day mortality rate among VRE colonization and infection was, respectively, 33.6% and 50.6% compared to 17.8% of non-colonized patients, and this difference was not statistically significant after adjustment for confounders in multivariate analysis.

VRE colonization or infection had no impact on survival in a large cohort of liver transplantrecipients.