title: Severe Sepsis After Living Donor Liver Transplantation: Risk Factors and Outcomes.
abstract: BACKGROUND
  The post-operative mortality and morbidity rates associated with living-donor liver transplantation (LDLT) are still relatively high. Several papers have reported the risk factors associated with post-operative infectious complications, but few have analyzed the risk factors with respect to the severity of sepsis. The aim of this study was to clarify the risk factors that affect severe sepsis after LDLT.
  
  
  METHODS
  For 63 LDLT patients at our institute, we compared peri-operative characteristics in 29 patients who developed sepsis after surgery and 34 patients who did not. The sepsis group was further divided into severe sepsis (n = 16) and sepsis (n = 13) subgroups to identify significant peri-operative risk factors.
  
  
  RESULTS
  Multivariate analysis identified 3 significant risk factors for post-operative sepsis after LDLT: ABO incompatibility (P = .015), low estimated glomerular filtration rates (<90 mL/min/1.73 m(2); P = .074), and low peripheral lymphocyte counts (<850/μL; P = .008). Multivariate analysis showed that the only significant risk factor for severe sepsis was a low pre-operative lymphocyte count (<850/μL; P = .01). In the 2 sepsis subgroups, the 5- and 10-year survival rates for the severe sepsis subgroup (37.5% and 37.5%) were significantly lower than for the sepsis subgroup (83.3% and 62.5%; P = .05). The lung was the most common site of severe sepsis (n = 8; 50.0%).
  
  
  CONCLUSIONS
  Patients who developed severe sepsis after LDLT had poor long-term survival, with pre-operative lymphocyte counts <850/μL being the significant risk factor. Pre-operative nutritional intervention and rehabilitation should be considered to improve LDLT outcomes.
authors: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. Electronic address: kazuyusota@yahoo.co.jp.
authors: K
authors: K
authors: Takeda
authors: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors: Y
authors: Y
authors: Sawada
authors: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors: T
authors: T
authors: Kumamoto
authors: Teikyo University Medical Center, Tokyo, Japan.
authors: K
authors: K
authors: Tanaka
authors: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors: I
authors: I
authors: Endo
mesh_terms: D000328:Adult; D001787:Blood Group Incompatibility / Q000150:complications; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D015996:Survival Rate; D016896:Treatment Outcome