Laici Cristiana, Gamberini Lorenzo, Bardi Tommaso, Siniscalchi Antonio, Reggiani Maria Letizia Bacchi, Faenza Stefano
Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Department of Statistics, Diagnostic and Experimental Medicine, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Transpl Infect Dis. 2018 Apr;20(2):e12834. doi: 10.1111/tid.12834. Epub 2018 Feb 12.
Infectious complications represent one of the main causes of perioperative morbidity and mortality of liver transplant recipients. The primary objective of this retrospective observational study was to evaluate incidence and etiology of early (within 1 month from surgery and occurring in the intensive care unit [ICU]) postoperative infections as well as donor- and recipient-related risk factors.
The data of 280 patients undergoing 299 consecutive liver transplant procedures from January 2012 to December 2015 were extracted from the Italian ICU registry database and hospital registries. Perioperative risk factors, etiology of infections, and antibiotic susceptibility of isolated microorganisms were taken into consideration.
Global incidence of postoperative infections was 21%. Pneumonia was the most frequent infection and, globally, gram-negative bacteria were the most common agents. Septic shock was present in 22% of infection cases and hospital mortality was higher in patients with postoperative infection. Preoperative chronic obstructive pulmonary disease, malnutrition, preoperative ascites, encephalopathy, and early re-transplantation were significantly associated to post orthotopic LT infections.
Infections represent a major cause of early postoperative morbidity and mortality. The impact of single risk factors and the results of their preoperative management should be further investigated in order to reduce the incidence and evolution of postoperative infections.
感染性并发症是肝移植受者围手术期发病和死亡的主要原因之一。这项回顾性观察性研究的主要目的是评估早期（术后1个月内且发生在重症监护病房[ICU]）术后感染的发生率和病因，以及供体和受体相关的危险因素。
从意大利ICU登记数据库和医院登记处提取了2012年1月至2015年12月期间连续接受299例肝移植手术的280例患者的数据。考虑围手术期危险因素、感染病因以及分离微生物的抗生素敏感性。
术后感染的总体发生率为21%。肺炎是最常见的感染，总体而言，革兰氏阴性菌是最常见的病原体。22%的感染病例出现感染性休克，术后感染患者的医院死亡率更高。术前慢性阻塞性肺疾病、营养不良、术前腹水、脑病和早期再次移植与原位肝移植术后感染显著相关。
感染是术后早期发病和死亡的主要原因。为了降低术后感染的发生率和进展，应进一步研究单一危险因素的影响及其术前管理的结果。
