Lim Seungjin, Kim Eun Jung, Lee Tae Beom, Choi Byung Hyun, Park Young Mok, Yang Kwangho, Ryu Je Ho, Chu Chong Woo, Lee Su Jin
Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Korean J Intern Med. 2018 Jul;33(4):798-806. doi: 10.3904/kjim.2017.230. Epub 2018 Feb 23.
BACKGROUND/AIMS: Infections following liver transplant (LT) remain a major cause of mortality. This study was conducted to evaluate risk factors for infection and to review clinical characteristics.
Medical records of patients who underwent LT from 2010 to 2014 were retrospectively analyzed. Binary logistic regression analysis was used to investigate risk factors of infection. Kaplan-Meier analysis was used to predict prognosis of infected and non-infected groups.
Of 185 recipients, 89 patients experienced infectious complications. The median follow-up period was 911 days (range, 9 to 2,031). The infected group had higher 1-year mortality (n = 22 [24.7%] vs. n = 8, [8.3%], p = 0.002), and longer postoperative admission days (mean: 53.7 ± 35.8 days vs. 28.3 ± 13.0 days, p < 0.001), compared to the non-infected group. High preoperative Model for End-Stage Liver Disease (MELD) score (odds ratio [OR], 1.057; 95% confidence interval [CI], 1.010 to 1.105; p = 0.016), deceased-donor type (OR, 5.475; 95% CI, 2.442 to 12.279; p < 0.001), and acute rejection (OR, 3.042; 95% CI, 1.241 to 7.454; p = 0.015) were independent risk factors associated with infection. Intra-abdominal infection (n = 35, 20.8%) was the major infectious complication. Among identified bacteria, Enterococcus species (28.4%) were major pathogens, followed by Escherichia coli and Klebsiella species.
High preoperative MELD score, deceased-donor type, and acute rejection were risk factors associated with infection. To prevent infections following surgery, it is important to determine the appropriate time of operation before the recipient has a high MELD score.
背景/目的：肝移植（LT）后感染仍然是主要的死亡原因。本研究旨在评估感染的危险因素并回顾临床特征。
对2010年至2014年接受肝移植患者的病历进行回顾性分析。采用二元逻辑回归分析来研究感染的危险因素。采用Kaplan-Meier分析来预测感染组和未感染组的预后。
185例受者中，89例发生感染并发症。中位随访期为911天（范围9至2031天）。与未感染组相比，感染组1年死亡率更高（22例[24.7%]对8例[8.3%]，p = 0.002），术后住院天数更长（平均：53.7±35.8天对28.3±13.0天，p < 0.001）。术前终末期肝病模型（MELD）评分高（比值比[OR]，1.057；95%置信区间[CI]，1.010至1.105；p = 0.016）、脑死亡供者类型（OR，5.475；95%CI，2.442至12.279；p < 0.001）和急性排斥反应（OR，3.042；95%CI，1.241至7.454；p = 0.015）是与感染相关的独立危险因素。腹腔内感染（35例，20.8%）是主要的感染并发症。在鉴定出的细菌中，肠球菌属（28.4%）是主要病原体，其次是大肠杆菌和克雷伯菌属。
术前MELD评分高、脑死亡供者类型和急性排斥反应是与感染相关的危险因素。为预防术后感染，在受者MELD评分升高之前确定合适的手术时间很重要。
