Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea.
Clin Transplant. 2023 May;37(5):e14956. doi: 10.1111/ctr.14956. Epub 2023 Mar 8.
Carbapenem-resistant Acinetobacter baumannii bacteremia (CRAB-B) is a fatal infectious complication of liver transplantation (LT). This study investigated the incidence, effects, and risk factors associated with CRAB-B during the early post-LT period. Among 1051 eligible LT recipients, 29 patients experienced CRAB-B within 30 days of LT with a cumulative incidence of 2.7%. In the patients with CRAB-B (n = 29) and matched controls (n = 145) by nested-case control design, the cumulative incidence of death on days 5, 10, and 30 from the index date was 58.6%, 65.5%, and 65.5%, and 2.1%, 2.8%, and 4.2%, respectively (p < .001). Pre-transplant MELD (OR 1.11, 95% confidence interval [CI] 1.04-1.19, p = .002), severe encephalopathy (OR 4.62, 95% CI 1.24-18.61, p = .025), donor body mass index (OR .57, 95% CI .41-.75, p < .001), and reoperation (OR 6.40, 95% CI 1.19-36.82, p = .032) were independent risk factors for 30-day CRAB-B. CRAB-B showed extremely high mortality within 30 days after LT, especially within 5 days after its occurrence. Therefore, assessment of risk factors and early detection of CRAB, followed by proper treatment, are necessary to control CRAB-B after LT.
碳青霉烯类耐药鲍曼不动杆菌菌血症（CRAB-B）是肝移植（LT）后致命的感染性并发症。本研究调查了 LT 后早期与 CRAB-B 相关的发生率、影响和危险因素。在 1051 名符合条件的 LT 受者中，有 29 名患者在 LT 后 30 天内发生 CRAB-B，累积发生率为 2.7%。在通过巢式病例对照设计匹配的 29 例 CRAB-B 患者（n=29）和 145 例对照患者中，从索引日期起第 5、10 和 30 天的累积死亡率分别为 58.6%、65.5%和 65.5%和 2.1%、2.8%和 4.2%（p<0.001）。移植前 MELD（OR 1.11，95%置信区间 [CI] 1.04-1.19，p=0.002）、严重脑病（OR 4.62，95%CI 1.24-18.61，p=0.025）、供体体重指数（OR.57，95%CI.41-.75，p<0.001）和再次手术（OR 6.40，95%CI 1.19-36.82，p=0.032）是 30 天 CRAB-B 的独立危险因素。CRAB-B 在 LT 后 30 天内死亡率极高，尤其是在发生后 5 天内。因此，评估危险因素和早期发现 CRAB，并进行适当的治疗，对于控制 LT 后 CRAB-B 是必要的。
