title: The impact of postoperative infection on long-term outcomes in liver transplantation.
abstract: BACKGROUND
  Postoperative infection (POI) prolongs inpatient stay, delays return to normal activity, and may be detrimental to long-term survival after cancer resections. This study sought to identify the impact of postoperative infection on liver transplantation outcomes.
  
  
  METHODS
  We analyzed our prospective database of 910 adult patients who underwent liver transplantation between 2000 and 2010 in a single UK center. POI was defined as pyrexia plus positive cultures from blood, sputum, urine, wound, or ascitic fluid. Patient demographic features and perioperative variables were analyzed for their effects on POI. The impacts of POI on overall survival (OS) and graft survival were analyzed using Kaplan-Meier curves with log-rank tests for significance, before entry into a multivariate regression analysis. We analyzed the effects of POI on the length of hospital stay (LOS) and the incidence of acute rejection episodes and readmissions within 1 year as secondary outcomes.
  
  
  RESULTS
  Patients who developed a postoperative chest or wound infection showed poorer OS at a mean of 7.0 versus 8.8 years (P = .009) and 7.0 versus 8.8 years (P = .003), respectively. Infection in blood, ascitic fluid, or urine showed no significant impact on survival. LOS was significantly increased among patients with a wound (median 21 vs 17 days, P = .011), a sputum (median 24 vs 17 days, P < .001), or a blood infection (median 32 vs 17 days, P < .001). Higher rates of intraoperative blood transfusion were observed among subjects who developed a chest or a wound infection. There was no difference in other variables between those who did versus did not develop an infection. Upon multivariate analysis, wound infection was the strongest independent predictor of OS (P = .007).
  
  
  CONCLUSIONS
  We demonstrated that wound or chest infections were associated with poorer OS. More aggressive prophylactic and/or therapeutic interventions targeting specific sites of infection may represent a simple and cost-effective measure to reduce hospital stay and improve OS.
authors.affiliation: Department of Hepatobiliary & Transplant Surgery, St James’ University Hospital, Leeds, United Kingdom. a.j.cockbain@leeds.ac.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Cockbain
authors.forename: P J
authors.initials: PJ
authors.lastname: Goldsmith
authors.forename: M
authors.initials: M
authors.lastname: Gouda
authors.forename: M
authors.initials: M
authors.lastname: Attia
authors.forename: S G
authors.initials: SG
authors.lastname: Pollard
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
mesh_terms: D006801:Humans; D007239:Infections / Q000209:etiology / Q000503:physiopathology*; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom