Soong R-S, Chan K-M, Chou H-S, Wu T-J, Lee C-F, Wu T-H, Lee W-C
Chang-Gung Transplantation Institute, Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, Chang-Gung University, College of Medicine, Taoyuan, Taiwan.
Transplant Proc. 2012 Apr;44(3):784-6. doi: 10.1016/j.transproceed.2012.03.028.
The high rate of early major infections in liver transplantation recipients is due to their compromised immune-system. We examined the risk factors of early major infection in living donor liver transplantation (LDLT).
From January 2004 to December 2010, 242 patients undergoing LDLT were enrolled in the prospective cohort. We prospectively collected their clinical and demographic variables, operative details, and posttransplant complications.
One hundred thirty-nine patients (57.7%) experienced 252 episodes of early infection posttransplantation: bloodstream septicemia (n = 46, 18.3%), urinary tract (n = 34; 14.1%), pneumonia (n = 64; 25.4%), peritonitis (n = 62; 25.7%), and catheter related (n = 46; 19%). The most frequent Gram-positive bacteria were coagulase-negative staphylococci (n = 52; 16.9%), followed by Staphylococcus aureus (n = 32; 10.4%). The most common Gram-negative bacteria were Escherichia coli (n = 27; 8.8%); Acinetobacter baumannii (n = 29; 9.4%), Pseudomonas aureos (n = 18; 5.8%), and Sternotrophomonas maltophilia (n = 18; 5.8%). Upon multivariate logistic regression analysis, the risk factors for early major infection were a high creatinine level (odds ratio = 1.481), a long anhepatic arterial phase (1.01), a reoperation (6.417), young age (1.040), and non-hepatocellular carcinoma recipient (2.141).
Early major infection after LDLT was high with Gram-positive bacteria, the most common etiologies. Prolonged anhepatic arterial phase, renal insufficiency, and reoperation were risk factors for an early major infection.
肝移植受者早期严重感染率较高是由于其免疫系统受损。我们研究了活体肝移植（LDLT）中早期严重感染的危险因素。
2004年1月至2010年12月，242例行LDLT的患者纳入前瞻性队列研究。我们前瞻性地收集了他们的临床和人口统计学变量、手术细节以及移植后并发症。
139例患者（57.7%）移植后发生252次早期感染：血流败血症（n = 46，18.3%）、尿路感染（n = 34；14.1%）、肺炎（n = 64；25.4%）、腹膜炎（n = 62；25.7%）以及导管相关感染（n = 46；19%）。最常见的革兰氏阳性菌是凝固酶阴性葡萄球菌（n = 52；16.9%），其次是金黄色葡萄球菌（n = 32；10.4%）。最常见的革兰氏阴性菌是大肠杆菌（n = 27；8.8%）；鲍曼不动杆菌（n = 29；9.4%）、金黄色假单胞菌（n = 18；5.8%）以及嗜麦芽窄食单胞菌（n = 18；5.8%）。多因素逻辑回归分析显示，早期严重感染的危险因素包括肌酐水平升高（比值比 = 1.481）、无肝动脉期延长（1.01）、再次手术（6.417）、年轻（1.040）以及非肝细胞癌受者（2.141）。
LDLT后早期严重感染发生率较高，革兰氏阳性菌是最常见的病因。无肝动脉期延长、肾功能不全以及再次手术是早期严重感染的危险因素。
