Explore The Risk Factors Of Early-stage Bacterial Infections After Orthotopic Liver Transplantation And Evaluate The Value Of Tumor Necrosis Factor-α For The Early Diagnosis

Objective: To explore the risk factors of early-stage infection after liver transplantation，and to evaluate the value of tumor necrosis factor-α(TNF-α) for the early diagnosis.Methods: A series of117patients who received orthotopic liver transplantation(OLT)surgeries in our department between March2004and April2010was recruited in this study.Then we collected and analyzed the clinical data retrospectively. Statistical analysis system(SPSS) software was adopted to perform statistical analysis. Chi-square test, t-test andWilcoxon rank sum test were used to analyze the clinical data and compute thesignificance of the incidences of early-stage infection after liver transplantation. Binarylogistic regression was performed to screen out the risk factors of early postoperativeinfection in OLT patients, and multiple logistic regression analyses were performed tocompute the independent risk factors.The value of serum TNF-α was tested in30patientswho received OLT with9patients infected between March2009and April2010. Theclinical symptoms and the value of white blood cell were also recorded and the changingpoint was compared with the serum TNF-α.Results:(1)19patients (19/117,16.24%) occurred pulmonary bacterial infection with1patient died. The independent risk factors of early-stage postoperative pulmonary bacterialinfections after OLT were age, preoperative heavy smoking and a history of chronic lungdisease, with the odds ratios at6.483(95%CI1.681～25.007，P=0.007) and5.425(95%CI1.693～17.385，P=0.004).(2)22patients (22/117,18.80%) occurred pulmonary bacterialinfection without any patient died. The independent risk factors of early-stagepostoperative intra-abdominal bacterial infections after OLT were preoperative anemia(<90g/l) and postoperative abdominal hemorrhage(72h>400ml),with the odds ratios at10.984(95%CI2.157～55.934，P=0.004) and5.496(95%CI1.572～19.208，P=0.008).(3)6patients occurred both intra-abdominal and pulmonary infection. There was nosignificant correlation between early-stage postoperative pulmonary infection andearly-stage postoperative intra-abdominal infection（P>0.05）.(4) Serum WBC and TNF-αelevated during the postoperative three days in9infected patients(9/30) who received OLT between March2009and April2010. There was statistical significance compared withthe preoperative values (P <0.05). The values of serum WBC and TNF-α decreased quicklyafter post-op3days. The values of serum WBC and TNF-α usually re-increased before theinfection symptoms appeared. The values of serum WBC re-elevated earlier than theinfection symptoms appeared0-2(0.875±0.83) days. And serum TNF-α values re-elevatedearlier than the clinical symptoms appeared0-3(1.78±1.09) days. Paired T-test showedthere was statistical significance (P <0.05) between WBC and TNF-α changing point.Conclusions: Bacterial infection is a common complication after liver transplantation.Age，heavy smoking and a history of chronic lung disease and are the independent riskfactors of early-stage postoperative pulmonary bacterial infections. Preoperative anemia(<90g/l), as well as postoperative intra-abdominal hemorrhage (72h>400ml) is anindependent risk factor of early-stage postoperative intra-abdominal bacterial infections.Monitoring the change of TNF-α contribute to the earlier diagnosis of early-stage bacterialinfection after OLT.