Incicco Simone, Tonon Marta, Zeni Nicola, Gambino Carmine, Gagliardi Roberta, Calvino Valeria, Barone Anna, Zilio Gianluca, Feltracco Paolo, Burra Patrizia, Cillo Umberto, Angeli Paolo, Piano Salvatore
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, Italy.
Anesthesiology and Intensive Care Unit, Department of Medicine (DIMED), University and Hospital of Padova, Padua, Italy.
JHEP Rep. 2023 Jun 7;5(9):100808. doi: 10.1016/j.jhepr.2023.100808. eCollection 2023 Sep.
BACKGROUND & AIMS: Bacterial infections are frequent in patients with cirrhosis and increase the risk of death and drop-out from liver transplant (LT) waiting list. In patients with bacterial infections, LT is frequently delayed because of the fear of poor outcomes. We evaluated the impact of pre-LT infections on post-LT complications and survival.
From 2012 to 2018, consecutive patients transplanted at the Hospital of Padua were identified and classified in two groups: patients surviving an episode of bacterial infection within 3 months before LT (study group) and patients without infections before LT (control group). Post-LT outcomes (complications, new infections, survival) were collected.
A total of 466 LT recipients were identified (study group n = 108; control group n = 358). After LT, the study group had a higher incidence of new bacterial (57% 20%, <0.001) and fungal infections (14% 5%, = 0.001) and of septic shock (8% 2%, = 0.004) than the control group. Along with the model for end-stage liver disease (MELD) score and alcohol-related cirrhosis, bacterial infection pre-LT was an independent predictor of post-LT infections (odds ratio = 3.92; <0.001). Nevertheless, no significant difference was found in 1-year (88% 89%, = 0.579) and 5-year survival rates (76% 75%, = 0.829) between the study group and control group. Within the study group, no association was found between the time elapsed from infection improvement/resolution to LT and post-LT outcomes.
Patients with pre-LT infections have a higher risk of new bacterial and fungal infections and of septic shock after LT. However, post-LT survival is excellent. Therefore, as soon as the bacterial infection is improving/resolving, transplant should not be delayed, but patients with pre-transplant bacterial infections require active surveillance for infections after LT.
Bacterial infections increase mortality and delay transplant in patients with cirrhosis awaiting liver transplantation (LT). Little is known about the impact of adequately treated infections before LT on post-transplant complications and outcomes. The study highlights that pre-LT infections increase the risk of post-LT infections, but post-LT survival rates are excellent despite the risk. These findings suggest that physicians should not delay LT because of concerns about pre-LT infections, but instead should actively monitor these patients for infections after surgery.
细菌感染在肝硬化患者中很常见，会增加死亡风险以及从肝移植（LT）等待名单中退出的几率。在细菌感染患者中，由于担心预后不佳，肝移植常常被推迟。我们评估了肝移植前感染对肝移植后并发症和生存率的影响。
2012年至2018年期间，对帕多瓦医院连续进行移植的患者进行识别，并分为两组：在肝移植前3个月内经历过一次细菌感染且存活的患者（研究组）和肝移植前未感染的患者（对照组）。收集肝移植后的结果（并发症、新感染、生存率）。
共识别出466例肝移植受者（研究组n = 108；对照组n = 358）。肝移植后，研究组新细菌感染（57%对20%，P<0.001）、真菌感染（14%对5%，P = 0.001）和感染性休克（8%对2%，P = 0.004）的发生率均高于对照组。除终末期肝病模型（MELD）评分和酒精性肝硬化外，肝移植前的细菌感染是肝移植后感染的独立预测因素（比值比 = 3.92；P<0.001）。然而，研究组和对照组在1年生存率（88%对89%，P = 0.579）和5年生存率（76%对75%，P = 0.829）方面未发现显著差异。在研究组内，从感染改善/消退到肝移植的时间与肝移植后的结果之间未发现关联。
肝移植前感染的患者肝移植后发生新细菌和真菌感染以及感染性休克的风险更高。然而，肝移植后的生存率良好。因此，一旦细菌感染有所改善/消退，不应推迟移植，但肝移植前有细菌感染的患者在肝移植后需要积极监测感染情况。
细菌感染会增加等待肝移植（LT）的肝硬化患者的死亡率并延迟移植。对于肝移植前充分治疗的感染对移植后并发症和结果的影响知之甚少。该研究强调，肝移植前感染会增加肝移植后感染的风险，但尽管有风险，肝移植后的生存率良好。这些发现表明，医生不应因担心肝移植前感染而推迟肝移植，而应在术后积极监测这些患者是否感染。
