Abstract: Objective:To investigate the risk factors of bloodstream infectionrelated death after liver transplantation.
MethodsThe retrospective casecontrol study was adopted. The clinical data of the 107 patients with bloodstream infection from 365 liver transplantation patients who were admitted to the Third Xiangya Hospital of Central South University (220 patients) and South Central Hospital Affiliated to Wuhan University (145 patients) from January 1, 2002 to December 31, 2015 were collected. The patients received modified piggyback liver transplantation. The second or third generation celphalosporin or carbapenems antibiotics were preventively used against infection according to the bacterial culture results before surgery, and the immune inhibitor basic program after surgery was FK506+prednisone. The observation indicators included: (1)the bloodstream infection status after liver transplantation: incidence of bloodstream infection, frequency of bloodstream infection, inadequate antiinfection treatment, primary infection position, microorganism infection type, bacterial culture results and bloodstream infectionrelated mortality. (2) The risk factors of blood stream infectionrelated death after liver transplantation in univariate and multivariate analyses in cluded: the gender, age, resource of donor, usage of immune inhibitor, time between infection and liver transplantation, infection temperature, primary infection position(intraperitoneal or biliary infection), pathogenic microorganism type, nosocomial infection, inadequate antibiotic usage, serum creatinine level, serum albumin (Alb) level, white blood cell (WBC) in peripheral blood, lymphocyte in peripheral blood, platelet (PLT) in peripheral blood and septic shock indexes. The patients were followed up by outpatient examination and telephone interview up to January 31, 2016, the followup contents included the survival status of the patients, vital signs, using status of immune inhibitor, immune inhibitor concentration, blood routine, biochemical indexes, surgery, other infectionrelated complications and acute rejection. Continuous variables with normal distribution were represented as ±s. The univariate analysis was done by the Chisquare test. The multivariate analysis was done by the Logistic regression model.
Results: (1)The bloodstream infection status after liver transplantation：186 bloodstream infections were happened in 107 patients undergoing liver transplantation, with a total incidence of bloodstream infection of 29.32%(107/365). The incidence of bloodstream infection was 28.18%(62/220) in the Third Xiangya Hospital of Central South University and 31.03%(45/145) in the South Central Hospital Affiliated to Wuhan University , with no statistical difference (χ²=0.186, P>0.05). Of 107 patients, 56 patients had once bloodstream infection, 31 had twice bloodstream infection and 20 had three times or more bloodstream infection(frequency of the most bloodstream infection was 6). The inadequate antiinfection treatment was applied to the 41.12%(44/107)of patients with liver transplantation and bloodstream infection. The number of patients with primary infection positions in abdomen, lung, urethra, intravascular catheter and unknown sites were 40, 39, 3, 1 and 24, respectively. The Gram positive bacteria, Gram negative bacteria, fungus and mixed infection of microorganism infection type were detected in 28, 24, 4 and 51 patients, respectively. There were 102 patients with nosocomial infection. Bacteria culture results in 186 strains of blood sample illustrated: 84 strains were Gram positive bacteria as major pathogenic bacteria, among which enterococcus (31 strains) and staphylococcus aureus (23 strains) were dominant strains. The bloodstream infectionrelated mortality was 37.38%(40/107), including 35 patients dying of septic shock. (2) The univariate analysis showed that the gender, resource of the donor, infection temperature, type of microorganism, serum creatinine level, serum Alb level, WBC in peripheral blood, PLT in peripheral blood and septic shock were the risk factors affecting bloodstream infectionrelated death after liver transplantation (χ²=5.801, 5.920, 13.047, 12.776, 11.366, 7.976, 25.173, 9.289, 51.905, P<0.05).The multivariate analysis showed that serum Alb level<30 mg/L and septic shock were the independent risk factors affecting bloodstream infectionrelated death after liver transplantation (OR=5.839, 44.983, 95% confidence interval: 1.145-29.767, 12.606-160.514, P<0.05).
Conclusion: It is prone to happen bloodstream infection after liver transplantation, and serum Alb level < 30mg/L and septic shock are the independent risk factors affecting bloodstream infectionrelated death after liver transplantation.