Poor outcomes of early recurrent post-transplant bloodstream infection in living-donor liver transplant recipients
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ORIGINAL ARTICLE
Poor outcomes of early recurrent post-transplant bloodstream infection in living-donor liver transplant recipients Si-Ho Kim 1 & Seok Jun Mun 2 & Jae-Hoon Ko 3 & Kyungmin Huh 3 & Sun Young Cho 3 & Cheol-In Kang 3 & Doo Ryeon Chung 3 & Gyu-Seong Choi 4 & Jong Man Kim 4 & Jae-Won Joh 4 & Kyong Ran Peck 3 Received: 14 June 2020 / Accepted: 14 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Bloodstream infection (BSI) is a common complication after living-donor liver transplantation (LDLT). Some patients develop recurrent BSIs. We evaluated the impacts of early recurrent BSIs (ER-BSIs) on outcomes in LDLT recipients. LDLT cases between 2008 and 2016 were included. Early BSI (E-BSI) was defined as a BSI event that occurred within 2 months after LDLT. ER-BSIs were defined as new-onset BSIs within 2 months due to another pathogen at a ≥ 48-h interval or a relapse of BSIs by the same pathogen at a ≥ 1-week interval, with negative cultures in between. The primary objective was evaluating the all-cause mortality of each group of LDLT recipients (90 days and 1 year). The secondary objectives were analyzing associated factors of each all-cause mortality and risk factors for early single BSI and ER-BSI. Among 727 LDLT recipients, 108 patients experienced 149 events of E-BSI with 170 isolated pathogens. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. The 1-year survival rates of patients without BSI, with early single BSI event, and with ER-BSIs were 92.4%, 81.3%, and 28.6%, respectively. ER-BSI was the most significant risk factor for 1-year mortality (adjusted HR = 5.31; 95% CI = 2.27–12.40). Intraabdominal and/or biliary complications and early allograft dysfunction were risk factors for both early single BSI and ERBSI. Interestingly, longer cold ischemic time and recipient operative time were associated with ER-BSI. LDLT recipients with ER-BSI showed very low survival rates accompanied by intra-abdominal complications. Clinicians should prevent BSI recurrence by being aware of intra-abdominal complications. Keywords Living-donor liver transplantation . Bacteremia . Fungemia . Recurrence . Mortality
Introduction Si-Ho Kim and Seok Jun Mun contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-04074-5) contains supplementary material, which is available to authorized users. * Kyong Ran Peck [email protected] 1
Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
2
Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, South Korea
3
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
4
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Successful management of infectious diseases is key to
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