title: Identifying a targeted population at high risk for infections after liver transplantation in the MELD era.
abstract: Impact of model for end-stage liver disease (MELD) scoring system on post-transplant infections and associated risk factors are unknown. Infections <90 d post-transplant were assessed in 277 consecutive liver transplant recipients from 1999 to 2008. "High-risk" factors for infections were pre-defined as MELD score >30, ICU stay >48 h prior to transplant, intraoperative transfusion ≥15 units, retransplantation, post-transplant dialysis, or reoperation. Of the 240 recipients in the MELD era (2002-2008), 48.5% had any high-risk factor. The OR for infection was 1.69, 2.00, 18.00, and 4.50 in recipients with any 1, 2, 3, and ≥4 high-risk factors, respectively (χ(2) for trend, p < 0.001). In logistic regression model, recipient age (OR 1.12, p < 0.05) and any high-risk factor (OR 2.42, p < 0.05) were associated with infections. Compared with 37 pre-MELD recipients, the overall infections and mortality at 12 months did not differ in the two eras. In Cox regression model, recipient age (OR 1.09, p < 0.05) and any high-risk factor (OR 2.42, p < 0.05) remained associated with infections. The overall frequency of infections did not increase in the MELD era. Pre-defined risk factors accurately predicted the risk of infections in these patients.
authors.affiliation: Veteran's Affair Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Cacciarelli
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D016867:Immunocompromised Host; D007239:Infections / Q000453:epidemiology* / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology