Kim Y J, Yoon J H, Kim S I, Choi H J, Choi J Y, Yoon S K, You Y-K, Kim D-G
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, The Seongae Hospital, College of Medicine, Seoul, Republic of Korea.
Transplant Proc. 2018 May;50(4):1153-1156. doi: 10.1016/j.transproceed.2018.01.036.
Uncontrolled infections are known to be an absolute contraindication for liver transplantation; however, the posttransplant prognosis of recipients treated for pretransplant infection is unclear. The aim of this study was to analyze pretransplant infections among liver transplant recipients and to determine their impact on posttransplant clinical outcomes.
This study retrospectively analyzed 357 subjects who had undergone living-donor liver transplantation between January 2008 and May 2014.
Among 357 recipients, 71 patients (19.8%) had 74 episodes of infectious complications before liver transplantation. These complications consisted of pneumonia (n = 13), spontaneous bacterial peritonitis (n = 12), catheter-related infection (n = 10), urinary tract infection (n = 12), biliary tract infection (n = 6), and skin and soft-tissue infection (n = 3). Twenty-six patients experienced 29 episodes of bacteremia, and the most common pathogens were coagulase-negative staphylococci (n = 8), followed by Klebsiella pneumoniae (n = 7), Staphylococcus aureus (n = 4), and Streptococcus species (n = 3). Twenty-one bacteremic episodes (70%) occurred within 1 month before transplantation (n = 4). Recipients with pretransplant infections had significantly more frequent posttransplant infections (71.8% [51 of 71] vs 47.2% [35 of 286]; P = .0001), posttransplant bacteremia (33.8% [24 of 71] vs 20.3% [58 of 286]; P = .015), and longer posttransplant intensive care unit stays (11.2 ± 10.7 days vs 7.3 ± 4.2 days; P = .0004) than those without pretransplant infections. However, episodes of rejection (P = .36), length of hospitalization (P = .10), 28-day mortality (P = .31), and 1-year mortality (P = .61) after transplantation were not significantly different between the 2 groups.
Pretransplant infection had an impact on posttransplant morbidity, although not on rejection and mortality. Alertness for posttransplant infection and proper management (including effective antimicrobial coverage) would improve patient morbidity.
已知未控制的感染是肝移植的绝对禁忌证；然而，移植前感染接受治疗的受者移植后的预后尚不清楚。本研究的目的是分析肝移植受者移植前的感染情况，并确定其对移植后临床结局的影响。
本研究回顾性分析了2008年1月至2014年5月期间接受活体肝移植的357例受试者。
在357例受者中，71例患者（19.8%）在肝移植前发生了74次感染并发症。这些并发症包括肺炎（n = 13）、自发性细菌性腹膜炎（n = 12）、导管相关感染（n = 10）、尿路感染（n = 12）、胆道感染（n = 6）以及皮肤和软组织感染（n = 3）。26例患者发生了29次菌血症，最常见的病原体是凝固酶阴性葡萄球菌（n = 8），其次是肺炎克雷伯菌（n = 7）、金黄色葡萄球菌（n = 4）和链球菌属（n = 3）。21次菌血症发作（70%）发生在移植前1个月内（n = 4）。移植前有感染的受者移植后感染（71.8% [71例中的51例] 对47.2% [286例中的35例]；P = .0001）、移植后菌血症（33.8% [71例中的24例] 对20.3% [286例中的58例]；P = .015）的发生率显著更高，且移植后在重症监护病房的住院时间更长（11.2 ± 10.7天对7.3 ± 4.2天；P = .0004）。然而，两组移植后的排斥反应发作次数（P = .36）、住院时间（P = .10）、28天死亡率（P = .31）和1年死亡率（P = .61）无显著差异。
移植前感染对移植后发病率有影响，尽管对排斥反应和死亡率没有影响。对移植后感染保持警惕并进行适当管理（包括有效的抗菌覆盖）将改善患者的发病率。
