title: The impact of infections on delisting patients from the liver transplantation waiting list.
abstract: Approximately 20% of the patients listed for liver transplantation die before transplantation can be accomplished. Understanding risk factors for waiting list mortality may help to improve survival and organ allocation. Infections are very common in patients with cirrhosis and are associated with significant morbidity and mortality. This study analysed the frequency and characteristics of infections in patients awaiting liver transplantation, identified risk factors for withdrawal from the waiting list and evaluated the impact of infections on the clinical outcome. A retrospective analysis of consecutive patients listed for liver transplantation in Rotterdam, the Netherlands from 2007 to 2014 was conducted. Infections occurred in 144 of 327 studied patients (44%). In this cohort, 23.4% of the patients on the liver transplantation waiting list were delisted or died before transplantation. Patients with an infection were 5.2 times more likely to become delisted than noninfected patients. In the 30 days after the first infection, patients were 33.8 times more likely to become delisted compared to noninfected patients. High age, high MELD score, refractory ascites and inappropriate antibiotic therapy were independent predictors for delisting due to infection. Infections occur frequently in patients on the liver transplantation waiting list. Emphasis on appropriate and timely antimicrobial therapy is required.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Louise J M
authors.identifier: http://orcid.org/0000-0001-7342-4654
authors.initials: LJM
authors.lastname: Alferink
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Rosalie C
authors.identifier: http://orcid.org/0000-0003-1032-495X
authors.initials: RC
authors.lastname: Oey
authors.affiliation: Liver Centre, Toronto Western & General Hospital, University Health Network, Toronto, Canada.
authors.forename: Bettina E
authors.identifier: http://orcid.org/0000-0001-8307-3341
authors.initials: BE
authors.lastname: Hansen
authors.affiliation: Division Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Wojciech G
authors.identifier: http://orcid.org/0000-0002-3096-4893
authors.initials: WG
authors.lastname: Polak
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Henk R
authors.identifier: http://orcid.org/0000-0002-1299-0553
authors.initials: HR
authors.lastname: van Buuren
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Robert A
authors.identifier: http://orcid.org/0000-0002-1932-7412
authors.initials: RA
authors.lastname: de Man
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Carolina A M
authors.identifier: http://orcid.org/0000-0002-2766-5147
authors.initials: CAM
authors.lastname: Schurink
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Herold J
authors.identifier: http://orcid.org/0000-0002-7203-8126
authors.initials: HJ
authors.lastname: Metselaar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014850:Waiting Lists / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents
keywords: infection; liver transplantation; mortality; waiting list