Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan ; Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
PLoS One. 2013 Sep 2;8(9):e72893. doi: 10.1371/journal.pone.0072893. eCollection 2013.
Liver transplantation is the only therapeutic modality for patients with acute-on chronic liver failure (ACLF). These patients are at high risk for bacterial infections while awaiting transplantation. The aim of this study was to elucidate whether an adequately treated bacterial infection influences the outcomes after transplantation in this patient population.
METHODOLOGY/PRINCIPAL FINDINGS: 54 recipients (median age, 49.5 years [range, 22-60]) of adult-to-adult living donor liver transplant (LDLT) for ACLF were categorized as those with pretransplant infection (Group 1, n=34) or without pretransplant infection (Group 2, n=20) for retrospective analyses. With the exception of a higher male-female ratio (P=0.046) and longer length of pretransplant hospital stay (P=0.026) in Group 1, similar demographic, laboratory and clinical features were found in both groups. Patients in Group 1 (totally 42 pretransplant infection episodes) were adequately treated with effective antibiotic(s) before receiving LDLT. All included patients were followed up until one year after transplantation or death. Sixty-one posttransplant infection episodes were found in an overall of 44 ACLF patients (27 in Group 1 vs. 15 in Group 2; P=0.352). Frequently encountered posttransplant infections were intraabdominal infection, pneumonia, bloodstream infection and urinary tract infection. Two patients died in each group (P=0.622). No significant difference was found in the length of posttransplant ICU stay, and in one-year survival, graft rejection, and posttransplant infection rate between both groups. The longer overall hospital stay (mean day, 89.0 vs. 65.5, P=0.024) found in Group 1 resulted from a longer pretransplant hospital stay receiving treatment for pretransplant infection(s) and/or awaiting transplantation.
These data suggested that an adequately treated pretransplant infection do not pose a significant risk for clinical outcomes including posttransplant fatality in recipients in adult-to-adult LDLT for ACLF.
肝移植是治疗慢加急性肝衰竭（ACLF）患者唯一的治疗方法。这些患者在等待移植时存在发生细菌感染的高风险。本研究旨在阐明在这一患者群体中，经适当治疗的细菌感染是否会影响移植后的结果。
方法/主要发现：54 例接受成人对成人活体肝移植（LDLT）治疗 ACLF 的患者被分为有移植前感染（第 1 组，n=34）和无移植前感染（第 2 组，n=20）进行回顾性分析。第 1 组中除了男性与女性的比例较高（P=0.046）和移植前住院时间较长（P=0.026）外，两组之间存在相似的人口统计学、实验室和临床特征。第 1 组中所有患者（共 42 例移植前感染）在接受 LDLT 之前都接受了有效的抗生素治疗。所有纳入的患者都随访至移植后 1 年或死亡。44 例 ACLF 患者中有 61 例发生了移植后感染（第 1 组 27 例，第 2 组 15 例；P=0.352）。常见的移植后感染是腹腔内感染、肺炎、血流感染和尿路感染。两组各有 2 例患者死亡（P=0.622）。两组之间在移植后 ICU 住院时间、1 年生存率、移植物排斥和移植后感染率方面均无显著差异。第 1 组中患者的总住院时间较长（平均天数，89.0 天 vs. 65.5 天，P=0.024），这是因为他们在接受移植前感染的治疗和/或等待移植时住院时间较长。
这些数据表明，在接受成人对成人 LDLT 治疗 ACLF 的患者中，经适当治疗的移植前感染不会对包括移植后死亡率在内的临床结果产生显著风险。
