Background: While some studies have examined the incidence of bloodstream infection (BSI) after liver transplantation, they were all based in single centers and did not identify BSIs treated in other hospitals.
Methods: We retrospectively examined a cohort of 7,912 adult liver transplant recipients from 24 transplant centers in California, Florida and New York using 2004-2012 Healthcare Cost and Utilization Project State Inpatient Databases, and identified demographics, comorbidities, cumulative one-year hospital charges, first episode of BSI and inpatient death during the transplant hospitalization or any subsequent readmission. Comorbidities, BSIs and other clinical events were defined using ICD-9-CM codes. Multilevel Cox regression models with random effects by transplant center were used to determine factors associated with BSI and death.
Results: The incidence of BSI after liver transplantation was 29% (n=2,298), with a range of 19% to 40% across transplant centers (Figure 1). Intra-abdominal, pulmonary and urinary tract infections occurred in 55%, 37% and 22% of hospitalizations wherein BSI was identified. BSI was associated with transplant failure/rejection (aHR 2.6), post-transplant laparotomy (aHR 1.4), increasing age (aHR 1.1/decade), female sex (aHR 1.1) and some comorbidities. Death occurred in 15% (n=1,180) of liver transplant recipients, with a range of 7% to 25% across transplant centers (Figure 2). Death was associated with BSI (aHR 4.7), transplant failure/rejection (aHR 1.4), post-transplant laparotomy (aHR 1.4), increasing age (aHR 1.1/decade), hepatitis C cirrhosis (aHR 1.2) and prior solid-organ transplant (aHR 1.4). Median one-year cumulative hospital charges were higher for patients who developed BSI within one year of transplant compared to patients who did not develop BSI ($661,533 versus $344,766, p <0.001).
Conclusion: BSI is a common and costly complication after liver transplantation, and is associated with a nearly five-fold increased risk of death. Transplant failure or rejection and post-transplant laparotomy are risk factors for BSI.
W. Chapman, None
M. Olsen, None
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