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Poor outcomes of early recurrent post-transplant bloodstream infection in living-donor liver transplant recipients

Authors
  • Kim, Si-Ho1
  • Mun, Seok Jun2
  • Ko, Jae-Hoon1
  • Huh, Kyungmin1
  • Cho, Sun Young1
  • Kang, Cheol-In1
  • Chung, Doo Ryeon1
  • Choi, Gyu-Seong1
  • Kim, Jong Man1
  • Joh, Jae-Won1
  • Peck, Kyong Ran1
  • 1 Sungkyunkwan University School of Medicine,
  • 2 Inje University College of Medicine, Inje University Busan Paik Hospital,
Type
Published Article
Journal
European Journal of Clinical Microbiology & Infectious Diseases
Publisher
Springer-Verlag
Publication Date
Oct 21, 2020
Pages
1–8
Identifiers
DOI: 10.1007/s10096-020-04074-5
PMID: 33089389
PMCID: PMC7577647
Source
PubMed Central
Keywords
License
Unknown

Abstract

Bloodstream infection (BSI) is a common complication after living-donor liver transplantation (LDLT). Some patients develop recurrent BSIs. We evaluated the impacts of early recurrent BSIs (ER-BSIs) on outcomes in LDLT recipients. LDLT cases between 2008 and 2016 were included. Early BSI (E-BSI) was defined as a BSI event that occurred within 2 months after LDLT. ER-BSIs were defined as new-onset BSIs within 2 months due to another pathogen at a ≥ 48-h interval or a relapse of BSIs by the same pathogen at a ≥ 1-week interval, with negative cultures in between. The primary objective was evaluating the all-cause mortality of each group of LDLT recipients (90 days and 1 year). The secondary objectives were analyzing associated factors of each all-cause mortality and risk factors for early single BSI and ER-BSI. Among 727 LDLT recipients, 108 patients experienced 149 events of E-BSI with 170 isolated pathogens. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. The 1-year survival rates of patients without BSI, with early single BSI event, and with ER-BSIs were 92.4%, 81.3%, and 28.6%, respectively. ER-BSI was the most significant risk factor for 1-year mortality (adjusted HR = 5.31; 95% CI = 2.27–12.40). Intra-abdominal and/or biliary complications and early allograft dysfunction were risk factors for both early single BSI and ER-BSI. Interestingly, longer cold ischemic time and recipient operative time were associated with ER-BSI. LDLT recipients with ER-BSI showed very low survival rates accompanied by intra-abdominal complications. Clinicians should prevent BSI recurrence by being aware of intra-abdominal complications. Electronic supplementary material The online version of this article (10.1007/s10096-020-04074-5) contains supplementary material, which is available to authorized users.

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