Risk factors of surgical site infection in liver transplantation recipients: a systematic review and meta-analysis

Surgical site infection (SSI) is a common and significant complication following organ transplantation, with liver transplantation (LT) being particularly susceptible to high infection rate. Despite its prevalence, no systematic meta-analysis has integrated evidence across major risk factors associated with post-LT SSI. We performed a systematic review and meta-analysis of studies from PubMed, Embase, Web of Science, and the Cochrane Database. We searched for eligible articles through April 2025. Of 8593 articles screened, 18 were included. R 4.1.3 software was used for this meta-analysis. Eighteen studies, including data from 9874 LT recipients and 1619 reported infection events, were included. Our analysis identified two LT-specific factors associated with elevated SSI risk: Roux-en-Y anastomosis (odds ratio (OR) 2.61, 95% confidence interval (CI) 1.95 to 3.26, I² = 43.37%), graft-to-recipient weight ratio (GRWR) <0.01 (OR 2.19, 95% CI 1.54 to 2.84, I² = 0%). In addition, re-transplantation, preoperative haemodialysis, biliary complications, and prior surgical history constitute significant risk factors. The meta-analysis revealed an overall SSI incidence rate of 21% across the investigated studies. Given the serious implications of SSI, increasing awareness of these risk factors and implementing targeted prevention strategies should be a priority for clinicians to reduce SSI rate after LT.