title: Impacts of pretransplant infections on clinical outcomes of patients with acute-on-chronic liver failure who received living-donor liver transplantation.
abstract: BACKGROUND
  Liver transplantation is the only therapeutic modality for patients with acute-on chronic liver failure (ACLF). These patients are at high risk for bacterial infections while awaiting transplantation. The aim of this study was to elucidate whether an adequately treated bacterial infection influences the outcomes after transplantation in this patient population.
  
  
  RESULTS
  54 recipients (median age, 49.5 years [range, 22-60]) of adult-to-adult living donor liver transplant (LDLT) for ACLF were categorized as those with pretransplant infection (Group 1, n=34) or without pretransplant infection (Group 2, n=20) for retrospective analyses. With the exception of a higher male-female ratio (P=0.046) and longer length of pretransplant hospital stay (P=0.026) in Group 1, similar demographic, laboratory and clinical features were found in both groups. Patients in Group 1 (totally 42 pretransplant infection episodes) were adequately treated with effective antibiotic(s) before receiving LDLT. All included patients were followed up until one year after transplantation or death. Sixty-one posttransplant infection episodes were found in an overall of 44 ACLF patients (27 in Group 1 vs. 15 in Group 2; P=0.352). Frequently encountered posttransplant infections were intraabdominal infection, pneumonia, bloodstream infection and urinary tract infection. Two patients died in each group (P=0.622). No significant difference was found in the length of posttransplant ICU stay, and in one-year survival, graft rejection, and posttransplant infection rate between both groups. The longer overall hospital stay (mean day, 89.0 vs. 65.5, P=0.024) found in Group 1 resulted from a longer pretransplant hospital stay receiving treatment for pretransplant infection(s) and/or awaiting transplantation.
  
  
  CONCLUSIONS
  These data suggested that an adequately treated pretransplant infection do not pose a significant risk for clinical outcomes including posttransplant fatality in recipients in adult-to-adult LDLT for ACLF.
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan ; Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Lin
authors.forename: Jien-Wei
authors.initials: JW
authors.lastname: Liu
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Shih-Hor
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.forename: Ting-Lung
authors.initials: TL
authors.lastname: Lin
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Li
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000382:microbiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
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