Cockbain A J, Goldsmith P J, Gouda M, Attia M, Pollard S G, Lodge J P A, Prasad K R, Toogood G J
Department of Hepatobiliary & Transplant Surgery, St James’ University Hospital, Leeds, United Kingdom.
Transplant Proc. 2010 Dec;42(10):4181-3. doi: 10.1016/j.transproceed.2010.09.026.
Postoperative infection (POI) prolongs inpatient stay, delays return to normal activity, and may be detrimental to long-term survival after cancer resections. This study sought to identify the impact of postoperative infection on liver transplantation outcomes.
We analyzed our prospective database of 910 adult patients who underwent liver transplantation between 2000 and 2010 in a single UK center. POI was defined as pyrexia plus positive cultures from blood, sputum, urine, wound, or ascitic fluid. Patient demographic features and perioperative variables were analyzed for their effects on POI. The impacts of POI on overall survival (OS) and graft survival were analyzed using Kaplan-Meier curves with log-rank tests for significance, before entry into a multivariate regression analysis. We analyzed the effects of POI on the length of hospital stay (LOS) and the incidence of acute rejection episodes and readmissions within 1 year as secondary outcomes.
Patients who developed a postoperative chest or wound infection showed poorer OS at a mean of 7.0 versus 8.8 years (P = .009) and 7.0 versus 8.8 years (P = .003), respectively. Infection in blood, ascitic fluid, or urine showed no significant impact on survival. LOS was significantly increased among patients with a wound (median 21 vs 17 days, P = .011), a sputum (median 24 vs 17 days, P < .001), or a blood infection (median 32 vs 17 days, P < .001). Higher rates of intraoperative blood transfusion were observed among subjects who developed a chest or a wound infection. There was no difference in other variables between those who did versus did not develop an infection. Upon multivariate analysis, wound infection was the strongest independent predictor of OS (P = .007).
We demonstrated that wound or chest infections were associated with poorer OS. More aggressive prophylactic and/or therapeutic interventions targeting specific sites of infection may represent a simple and cost-effective measure to reduce hospital stay and improve OS.
术后感染（POI）会延长住院时间，延迟恢复正常活动，并且可能对癌症切除术后的长期生存产生不利影响。本研究旨在确定术后感染对肝移植结局的影响。
我们分析了在英国一个中心于2000年至2010年间接受肝移植的910例成年患者的前瞻性数据库。POI定义为发热加血液、痰液、尿液、伤口或腹水培养阳性。分析患者人口统计学特征和围手术期变量对POI的影响。在进行多变量回归分析之前，使用Kaplan-Meier曲线和对数秩检验分析POI对总生存（OS）和移植物生存的影响，以检验其显著性。我们将POI对住院时间（LOS）以及1年内急性排斥反应发作和再入院发生率的影响作为次要结局进行分析。
发生术后胸部或伤口感染的患者，其平均总生存时间分别为7.0年和8.8年（P = 0.009）以及7.0年和8.8年（P = 0.003），生存情况较差。血液、腹水或尿液感染对生存无显著影响。伤口感染（中位数21天对17天，P = 0.011）、痰液感染（中位数24天对17天，P < 0.001）或血液感染（中位数32天对17天，P < 0.001）患者的住院时间显著延长。发生胸部或伤口感染的受试者术中输血率更高。发生感染与未发生感染的患者在其他变量上无差异。多变量分析显示，伤口感染是总生存的最强独立预测因素（P = 0.007）。
我们证明伤口或胸部感染与较差的总生存相关。针对特定感染部位采取更积极的预防和/或治疗干预措施可能是一种简单且具成本效益的措施，可减少住院时间并改善总生存。
