Risk Factors And Outcomes Of Donor-derived Infections After Liver Transplantation In West China:A Single-center Experience

Objective: To evaluate the risk factors of donor-derived infections among donation after cardiac death liver recipients and the outcomes of liver recipients with donor-derived infections.Methods: A retrospective study including 32 liver recipients underwent liver transplantations in The First Affiliated Hospital of Chongqing Medical University from December 2016 to December 2018 had been done.And the data of 32 corresponding liver donor was collected.The analysis of the following data was conducted:(1)the microbial and susceptibility tests results of donors and recipients during the peri-transplantation period;(2)sex,age,cause of death,duration of ICU stays,MDR microbial infections of donors;(3)sex,age,primary diseases,previous surgical or non-surgical intervention,previous transplantation,pre-transplant MELD scores of recipients;(4)survival state and time after liver transplantation.Then the chi-square tests were used to evaluate the differences of factors above between recipients with and without post-transplantation infections.Descriptive statistics were used tosummarize the microorganisms isolated from the specimens of recipients and the clinical data of recipients with DDI.Log-rank tests were used to evaluate the risk factors of DDI of recipients.Finally,Kaplan-Meier tests were used to evaluate the differences of survival state between recipients with/ without post-transplantation infections as well as differences between recipients with/ without DDI.Results: 9 cases of post-transplant infections were confirmed,through which 42 episodes of bacteria or fungi in 19 species were isolated in total,including 26 episodes of gram-positive bacteria,13 episodes of gram-negative bacteria and 3 episodes of fungi.3 cases of recipients with DDI were confirmed,1 with CRAB infection and the other 2 with CRKP infections,2 of the 3 recipients died with graft loss and the other 1 was alive with multiple focal abdominal infections.Recipients with post-transplant infections were statistically more likely to have infected with HBV,have undergone pre-LT TACE,received the grafts from older donors and donors with MDR micro-organisms infections.Single factor analysis found recipients with HBV infections,long ICU stays of donors and donors infected with MDR microorganisms were risk factors of post-LT DDI.Survival analysis identified there was no significant difference in survive between recipients with and without post-LT infection,at the meantime,recipients with DDIs had significant lower survival rates than recipients without DDIs.Conclusion: Gram-positive bacteria were the major causes of peri-LT infections while the post-LT DDIs were mainly caused by MDR gram-negative bacteria.Recipients with HBV infections,longer ICU stays of donors and donors infected with MDR microorganisms were the 3 risk factors for post-LT DDI.Survival data between post-LT infected recipients and none post-LT infected recipients were not significantly different while recipients with DDI had significant lower survival rates than recipients without DDIs.