title: DCD liver transplant infection: experience from a single centre in China.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the incidence, timing, location and risk factors for bacterial and fungal infections after donation after cardiac death (DCD) liver transplant and clearly delineate any relationship between infection and survival in DCD liver transplant recipients.
  
  
  METHODS
  We retrospectively reviewed 257 consecutive patients undergoing DCD liver transplant between October 2010 and May 2015 at our centre.
  
  
  RESULTS
  A total of 133 patients (51.8%) developed at least one bacterial or fungal infection episode. The predominant infection site was the respiratory tract, followed by the blood stream. Most of the infections occurred within the first week after liver transplant (61.9%). A recipient respiratory support time greater than 7 days (p = 0.041), post-transplant hospital time greater than 24 days (p = 0.002) and renal failure after DCD liver transplant (p = 0.039) were independent predictors of bacterial and fungal infection. The area under the receiver operating characteristic (ROC) curve (AUC) of the transplant infection risk assessment model was 0.788. The 1- and 3-year survival rates for recipients without infection were significantly increased compared with recipients with infection (96.1% and 89.0% vs. 81.5% and 75.9%, p = 0.007).
  
  
  CONCLUSIONS
  This is the first study that offers detailed data revealing the timing and incidence of bacterial and fungal infection among adult DCD liver transplant recipients. Bacterial and fungal infection occurs at a high rate during the first week after DCD liver transplant, especially in patients with prolonged respiratory support time and renal failure, and infection is related to increased hospital stay.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Tu
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: P
authors.initials: P
authors.lastname: Xiang
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: X
authors.initials: X
authors.lastname: Xu
authors.affiliation: Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhuang
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.|Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China.
authors.forename: S
authors.initials: S
authors.lastname: Zheng
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology* / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008107:Liver Diseases / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors