2308. Epidemiology and Risk Factors for Infection after Living Donor Liver Transplantation (LDLT)
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • LDLT final.pdf (1.0 MB)
  • Background:

    Infections are leading causes of morbidity among liver transplant (LT) patients. We aimed to study the incidence and risk factors of infection in LDLT patients.

    Methods:

    The medical records of 223 adult LDLT from 01/2000 to 08/2015 were reviewed for infections up to 1 year after transplant. We estimated the cumulative incidence of infection using the Kaplan Meier product limit method. Risk factors measured at baseline and over follow-up were analyzed with time-dependent Cox regression modeling.

    Results:

    The majority of patients were Caucasian (n=211, 95%) and male (n=144, 65%); median age was 55 years. The most common reason for transplantation was primary sclerosing cholangitis (38%).  Fifty six percent of patients developed an infection within 1 year (n=122), with the majority (80/122, or 66%) within 30 days of transplant.  The types of infection are shown in Figure 1.  Enterococcus sp. was the most frequent pathogen (29/55).  Multivariable analysis showed that MELD score (HR, per 10-point change: 1.65), history of recurrent pre-transplant infections (HR: 2.26), Roux-en-Y anastomosis (HR: 2.24), number of packed RBC transfusions (log-transformed; HR: 1.49), and biliary complications (HR: 3.79) were independently associated with a higher risk of infection.

    Conclusion:

    LDLT recipients are at high risk for infections, especially during the first 30 days after transplant. Most infections were hepatobiliary and related to surgery. LDLT recipients with higher MELD scores and those with history of recurrent infection were at increased risk of infection as well.  

     

     

    LDLT
(N=229)
,Study Cohort (n=223),Excluded, n=6
,Non-OI
(103)
,Both OI and Non-OI (13),OI
(6)
,Patients w/ Infection (122),Non OI (116),Fungal (2), Microbiologic (102),Syndromic (14),Bacterial (100),CDI (10),BSI (9),UTI (7),Abscess (6), Peritonitis (7),SSI (3),Other (3),Hepatobiliary (55),REASON FOR EXCLUSION, (n)
Pediatric (2)
Death on day of transplant (2)
No consent (2)
,OI (19) ,VZV (3),CMV (16)

     

     

     

     

     

     

     

     

     

    Figure 1: Types of Infection In the First Year Post –Transplant

    LDLT - Living donor liver transplant; OI –opportunistic infection; CMV – Cytomegalovirus; VZV – Varicella zoster virus; CDI – C. difficile infection; UTI – Urinary tract infection; SSI – surgical site infection

     

    Cybele Lara Abad, MD, Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Infectious Diseases, University of the Philippines, Manila, Philippines, Brian Lahr, MS, Biomedical Statistics and Informatics, Mayo Clinic, College of Medicine, Rochester, MN and Raymund R. Razonable, MD, FIDSA, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN

    Disclosures:

    C. L. Abad, None

    B. Lahr, None

    R. R. Razonable, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.