Pre-transplant multidrug-resistant infections in liver transplant recipients-epidemiology and impact on transplantation outcome

Gabriela T Lemos; Debora R B Terrabuio; Nathalia N Nunes; Alice T W Song; Isabel C V Oshiro; Luiz Augusto C D'Albuquerque; Anna S Levin; Edson Abdala; Maristela P Freire

doi:10.1111/ctr.15173

Pre-transplant multidrug-resistant infections in liver transplant recipients-epidemiology and impact on transplantation outcome

Clin Transplant. 2024 Jan;38(1):e15173. doi: 10.1111/ctr.15173. Epub 2023 Oct 25.

Authors

Gabriela T Lemos¹, Debora R B Terrabuio², Nathalia N Nunes¹, Alice T W Song³, Isabel C V Oshiro⁴, Luiz Augusto C D'Albuquerque³, Anna S Levin¹, Edson Abdala¹, Maristela P Freire^{1

4}

Affiliations

¹ Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, Sao Paulo, Brazil.
² Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, Sao Paulo, Brazil.
³ Division of Liver and Gastrointestinal Transplant, Hospital das Clínicas, Department of Surgery, University of São Paulo School of Medicine, Sao Paulo, Brazil.
⁴ Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, Sao Paulo, Brazil.

PMID: 37877950
DOI: 10.1111/ctr.15173

Abstract

Background: Cirrhotic patients are highly exposed to healthcare services and antibiotics. Although pre-liver transplantation (LT) infections are directly related to the worsening of liver function, the impact of these infections on LT outcomes is still unclear. This study aimed to identify the effect of multidrug-resistant microorganism (MDRO) infections before LT on survival after LT.

Methods: Retrospective study that included patients who underwent LT between 2010 and 2019. Variables analyzed were related to patients' comorbidities, underlying diseases, time on the waiting list, antibiotic use, LT surgery, and occurrences post-LT. Multivariate analyses were performed using logistic regression, and Cox regression for survival analysis.

Results: A total of 865 patients were included; 351 infections were identified in 259 (30%) patients, of whom 75 (29%) had ≥1 pre-LT MDRO infection. The most common infection was spontaneous bacterial peritonitis (34%). The agent was identified in 249(71%), 53(15%) were polymicrobial. The most common microorganism was Klebsiella pneumoniae (18%); the most common MDRO was ESBL-producing Enterobacterales (16%), and carbapenem-resistant (CR) Enterobacterales (10%). Factors associated with MDRO infections before LT were previous use of therapeutic cephalosporin (p = .001) and fluoroquinolone (p = .001), SBP prophylaxis (p = .03), ACLF before LT (p = .03), and days of hospital stay pre-LT (p < .001); HCC diagnosis was protective (p = .01). Factors associated with 90-day mortality after LT were higher MELD on inclusion to the waiting list (p = .02), pre-LT MDRO infection (p = .04), dialysis after LT (p < .001), prolonged duration of LT surgery (p < .001), post-LT CR-Gram-negative bacteria infection (p < .001), and early retransplantation (p = .004).

Conclusion: MDRO infections before LT have an important impact on survival after LT.

Keywords: ESBL-producing; Enterobacterales; carbapenem resistance; dialysis; meld; mortality; retransplantation; risk factors.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Bacterial Infections* / drug therapy
Bacterial Infections* / epidemiology
Bacterial Infections* / etiology
Carcinoma, Hepatocellular*
Communicable Diseases* / drug therapy
Humans
Liver Neoplasms*
Liver Transplantation* / adverse effects
Postoperative Complications / drug therapy
Retrospective Studies
Risk Factors

Substances

Anti-Bacterial Agents