Infectious complications in living-donor liver transplant recipients: a 9-year single-center experience.
BACKGROUND
Infectious complications following living-donor liver transplantation (LDLT) remain a major cause of morbidity and mortality. We analyzed the frequency and type of infectious complications according to the post-transplantation period, and their risk factors with regard to morbidity and mortality.


METHODS
We retrospectively analyzed 208 subjects who had undergone LDLT during a 9-year period.


RESULTS
The rate of infection was 1.69 per patient during the study period. The predominant infections were intra-abdominal infections (37.6%), primary bacteremia (17.4%), and pneumonia (14.5%). Within the first post-transplant month, 140 (39.9%) infections were detected, and catheter-related coagulase-negative staphylococci (44) were the most common infectious agents. During the 2-6-month post-transplant period, 109 infectious episodes occurred (31.1%), and Enterococcus sp. (n=16) related to biliary infection was the most frequent isolate. After the sixth month, 96 infectious episodes (29%) occurred, and biliary tract-related Escherichia coli (n=19) was the major causative organism. The overall mortality was 24.5% (51/208); 1-year survival rate was 88% (196/208). Post-transplant infection-related mortality was 52.9% (27/51). Biliary tract complications, such as biliary stenosis or leakage, significantly increased the mortality (P=0.01); however, reoperation (retransplantation or resurgery for biliary tract obstruction/leakage or to control bleeding) significantly reduced the mortality (P=0.01).


CONCLUSIONS
Our data showed that early catheter removal would mainly aid in reducing infectious complications in the 1-month post-transplantation period. Aggressive management, including reoperation, would lower the mortality in the LDLT recipients.
Kim
Y J
YJ
Department of Internal Medicine, Division of Infectious Disease, The Catholic University of Korea, College of Medicine, Seoul, Korea.
Kim
S I
SI
Wie
S H
SH
Kim
Y R
YR
Hur
J A
JA
Choi
J Y
JY
Yoon
S K
SK
Moon
I S
IS
Kim
D G
DG
Lee
M D
MD
Kang
M W
MW
D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D007723:Korea / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*