Kim Y J, Kim S I, Wie S H, Kim Y R, Hur J A, Choi J Y, Yoon S K, Moon I S, Kim D G, Lee M D, Kang M W
Department of Internal Medicine, Division of Infectious Disease, The Catholic University of Korea, College of Medicine, Seoul, Korea.
Transpl Infect Dis. 2008 Oct;10(5):316-24. doi: 10.1111/j.1399-3062.2008.00315.x. Epub 2008 May 26.
Infectious complications following living-donor liver transplantation (LDLT) remain a major cause of morbidity and mortality. We analyzed the frequency and type of infectious complications according to the post-transplantation period, and their risk factors with regard to morbidity and mortality.
We retrospectively analyzed 208 subjects who had undergone LDLT during a 9-year period.
The rate of infection was 1.69 per patient during the study period. The predominant infections were intra-abdominal infections (37.6%), primary bacteremia (17.4%), and pneumonia (14.5%). Within the first post-transplant month, 140 (39.9%) infections were detected, and catheter-related coagulase-negative staphylococci (44) were the most common infectious agents. During the 2-6-month post-transplant period, 109 infectious episodes occurred (31.1%), and Enterococcus sp. (n=16) related to biliary infection was the most frequent isolate. After the sixth month, 96 infectious episodes (29%) occurred, and biliary tract-related Escherichia coli (n=19) was the major causative organism. The overall mortality was 24.5% (51/208); 1-year survival rate was 88% (196/208). Post-transplant infection-related mortality was 52.9% (27/51). Biliary tract complications, such as biliary stenosis or leakage, significantly increased the mortality (P=0.01); however, reoperation (retransplantation or resurgery for biliary tract obstruction/leakage or to control bleeding) significantly reduced the mortality (P=0.01).
Our data showed that early catheter removal would mainly aid in reducing infectious complications in the 1-month post-transplantation period. Aggressive management, including reoperation, would lower the mortality in the LDLT recipients.
活体供肝肝移植（LDLT）后的感染性并发症仍然是发病和死亡的主要原因。我们根据移植后时期分析了感染性并发症的频率和类型，以及它们在发病和死亡方面的危险因素。
我们回顾性分析了在9年期间接受LDLT的208名受试者。
在研究期间，每位患者的感染率为1.69。主要感染为腹腔内感染（37.6%）、原发性菌血症（17.4%）和肺炎（14.5%）。在移植后的第一个月内，检测到140例感染（39.9%），导管相关凝固酶阴性葡萄球菌（44例）是最常见的感染病原体。在移植后2至6个月期间，发生了109次感染事件（31.1%），与胆道感染相关的肠球菌（n = 16）是最常见的分离株。在第六个月后，发生了96次感染事件（29%），与胆道相关的大肠杆菌（n = 19）是主要病原体。总死亡率为24.5%（51/208）；1年生存率为88%（196/208）。移植后感染相关死亡率为52.9%（27/51）。胆道并发症，如胆道狭窄或渗漏，显著增加死亡率（P = 0.01）；然而，再次手术（再次移植或因胆道梗阻/渗漏或控制出血而进行的再次手术）显著降低死亡率（P = 0.01）。
我们的数据表明，早期拔除导管主要有助于减少移植后1个月内的感染性并发症。积极的处理，包括再次手术，将降低LDLT受者的死亡率。
