Shah Harshal, Hellinger Walter C, Heckman Michael G, Diehl Nancy, Shalev Jefree A, Willingham Darrin L, Taner C Burcin, Perry Dana K, Nguyen Justin
Division of Infectious Disease; Parkview Medical Center, Pueblo, CO.
Liver Transpl. 2014 Aug;20(8):930-6. doi: 10.1002/lt.23890. Epub 2014 Jun 24.
Surgical site infections (SSIs) after liver transplantation (LT) are associated with an increased risk of graft loss and death. The incidence of SSIs after LT and their risk factors have been determined for first LT but not for second LT. The importance of reporting the incidence of SSIs risk-stratified by first LT versus second LT is not known. All patients undergoing second LT at a single institution between 2003 and 2011 (n = 152) were reviewed. The Kaplan-Meier method was used to estimate the cumulative SSI incidence. Relative risks (RRs) and 95% confidence intervals (CIs) from Cox proportional hazards regression models were used to evaluate associations of potential risk factors with SSIs after second LT. Thirty-one patients developed SSIs (6 superficial SSIs, 1 deep SSI, and 24 organ/space SSIs). The cumulative incidence of SSIs 30 days after LT was 20.8% (95% CI = 14%-27%), which was slightly but not significantly higher than the previously reported incidence of SSIs after first LT at our institution between 2003 and 2008 (16%, RR = 1.32, 95% CI = 0.90-1.93, P = .16). Units of transfused red blood cells [RR (doubling) = 1.38, 95% CI = 1.02-1.86, P = .04] and hepaticojejunostomy (RR = 2.22, 95% CI = 1.05-4.72, P = .04) were the only factors associated with SSIs after second LT in single-variable analysis. The associations weakened in a multivariate analysis (P = .07 and P = .07, respectively), potentially because of the correlation of red blood cell transfusions and hepaticojejunostomy (P = .08). In conclusion, the incidence of SSIs after second LT was slightly higher but not significantly different than the published incidence of SSIs (16%) after first LT at the same institution. Significant independent risk factors for SSIs after second LT were not identified. Risk stratification for retransplantation may not be necessary when the incidence of SSIs after LT is being reported.
肝移植（LT）术后手术部位感染（SSIs）与移植物丢失和死亡风险增加相关。LT术后SSIs的发生率及其危险因素已在首次LT中确定，但在二次LT中尚未确定。按首次LT与二次LT对SSIs发生率进行风险分层报告的重要性尚不清楚。对2003年至2011年间在单一机构接受二次LT的所有患者（n = 152）进行了回顾。采用Kaplan-Meier方法估计累积SSI发生率。Cox比例风险回归模型的相对风险（RRs）和95%置信区间（CIs）用于评估二次LT后潜在危险因素与SSIs的关联。31例患者发生了SSIs（6例表浅SSIs、1例深部SSI和24例器官/腔隙SSIs）。LT后30天SSIs的累积发生率为20.8%（95%CI = 14%-27%），略高于但不显著高于我们机构2003年至2008年间首次LT后报告的SSIs发生率（16%，RR = 1.32，95%CI = 0.90-1.93，P = 0.16）。输注红细胞单位[RR（加倍）= 1.38，95%CI = 1.02-1.86，P = 0.04]和肝空肠吻合术（RR = 2.22，95%CI = 1.05-4.72，P = 0.04）是单变量分析中与二次LT后SSIs相关的唯一因素。在多变量分析中，这些关联减弱（分别为P = 0.07和P = 0.07），可能是因为红细胞输注与肝空肠吻合术相关（P = 0.08）。总之，二次LT后SSIs的发生率略高于但与同一机构首次LT后公布的SSIs发生率（16%）无显著差异。未发现二次LT后SSIs的显著独立危险因素。报告LT后SSIs发生率时，可能无需对再次移植进行风险分层。
