title: Spontaneous bacterial peritonitis prevalence in pre-transplant patients and its effect on survival and graft loss post-transplant.
abstract: OBJECTIVE
  To investigate the incidence of spontaneous bacterial peritonitis (SBP) in pre-transplant patients and its effect on post transplant mortality and graft failure.
  
  
  METHODS
  We conducted a retrospective cohort study of patient records from the organ procurement and transplant network data set. Patients were identified by the presence of SBP pre-transplant. Univariate post-transplant survival models were constructed using the Kaplan-Meier technique and multivariate models were constructed using the Cox proportional hazards model. Variables that affected post-transplant graft survival were identified in the SBP population.
  
  
  RESULTS
  Forty-seven thousand eight hundred and eighty patient records were included in the analysis for both groups, and 1966 (4.11%) patients were identified in the data set as having pre-transplant SBP. Patients that had pre-transplant SBP had higher rates of graft loss from recurrent hepatitis C virus (HCV) (3.6%vs2.0%,P< 0.0001), infections leading to graft loss (1.9%vs1.3%,P= 0.02), primary non-function (4.3%vs3.0%,P< 0.0001) and chronic rejection (1.1%vs0.7%,P= 0.04). Kaplan-Meier survival analysis showed a statistically significant difference in all-cause survival in patients with a history of SBPvsthose without (P< 0.0001). Pre-transplant history of SBP was independently predictive of mortality due to recurrent HCV (HR = 1.11, 95%CI: 1.02-1.21,P< 0.017) after liver transplantation.
  
  
  CONCLUSIONS
  HCV patients prior to the advent of directing acting anti-viral agents had a higher incidence of pre-transplant SBP than other patients on the liver transplant wait list. SBP history pre-transplant resulted in a higher rate of graft loss due to recurrent HCV infection and chronic rejection.
authors.affiliation: Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Neeral L
authors.initials: NL
authors.lastname: Shah
authors.affiliation: Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Intagliata
authors.affiliation: Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Zachary H
authors.initials: ZH
authors.lastname: Henry
authors.affiliation: Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
keywords: Graft failure; Hepatitis C; Liver transplant; Spontaneous bacterial peritonitis