Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, Sao Paulo, Brazil.
Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, Sao Paulo, Brazil.
Clin Transplant. 2024 Jan;38(1):e15173. doi: 10.1111/ctr.15173. Epub 2023 Oct 25.
Cirrhotic patients are highly exposed to healthcare services and antibiotics. Although pre-liver transplantation (LT) infections are directly related to the worsening of liver function, the impact of these infections on LT outcomes is still unclear. This study aimed to identify the effect of multidrug-resistant microorganism (MDRO) infections before LT on survival after LT.
Retrospective study that included patients who underwent LT between 2010 and 2019. Variables analyzed were related to patients' comorbidities, underlying diseases, time on the waiting list, antibiotic use, LT surgery, and occurrences post-LT. Multivariate analyses were performed using logistic regression, and Cox regression for survival analysis.
A total of 865 patients were included; 351 infections were identified in 259 (30%) patients, of whom 75 (29%) had ≥1 pre-LT MDRO infection. The most common infection was spontaneous bacterial peritonitis (34%). The agent was identified in 249(71%), 53(15%) were polymicrobial. The most common microorganism was Klebsiella pneumoniae (18%); the most common MDRO was ESBL-producing Enterobacterales (16%), and carbapenem-resistant (CR) Enterobacterales (10%). Factors associated with MDRO infections before LT were previous use of therapeutic cephalosporin (p = .001) and fluoroquinolone (p = .001), SBP prophylaxis (p = .03), ACLF before LT (p = .03), and days of hospital stay pre-LT (p < .001); HCC diagnosis was protective (p = .01). Factors associated with 90-day mortality after LT were higher MELD on inclusion to the waiting list (p = .02), pre-LT MDRO infection (p = .04), dialysis after LT (p < .001), prolonged duration of LT surgery (p < .001), post-LT CR-Gram-negative bacteria infection (p < .001), and early retransplantation (p = .004).
MDRO infections before LT have an important impact on survival after LT.
肝硬化患者高度接触医疗保健服务和抗生素。尽管肝移植（LT）前感染与肝功能恶化直接相关，但这些感染对 LT 结局的影响尚不清楚。本研究旨在确定 LT 前多药耐药微生物（MDRO）感染对 LT 后生存的影响。
回顾性研究纳入 2010 年至 2019 年间接受 LT 的患者。分析的变量与患者的合并症、基础疾病、等待名单上的时间、抗生素使用、LT 手术以及 LT 后发生的情况有关。使用逻辑回归和 Cox 回归进行生存分析进行多变量分析。
共纳入 865 例患者；259 例（30%）患者中发现 351 例感染，其中 75 例（29%）有≥1 例 LT 前 MDRO 感染。最常见的感染是自发性细菌性腹膜炎（34%）。在 249 例（71%）中确定了病原体，53 例（15%）为混合感染。最常见的微生物是肺炎克雷伯菌（18%）；最常见的 MDRO 是产 ESBL 的肠杆菌科（16%）和耐碳青霉烯肠杆菌科（10%）。LT 前 MDRO 感染相关的因素是之前使用治疗性头孢菌素（p=0.001）和氟喹诺酮（p=0.001）、LT 前 SBP 预防（p=0.03）、LT 前 ACLF（p=0.03）和 LT 前住院天数（p<0.001）；HCC 诊断具有保护作用（p=0.01）。LT 后 90 天死亡率相关的因素是纳入等待名单时更高的 MELD（p=0.02）、LT 前 MDRO 感染（p=0.04）、LT 后透析（p<0.001）、LT 手术时间延长（p<0.001）、LT 后耐碳青霉烯革兰氏阴性菌感染（p<0.001）和早期再移植（p=0.004）。
LT 前 MDRO 感染对 LT 后生存有重要影响。
