This study investigated perioperative clinical risk factors for early post-transplant bacteremia in patients undergoing living donor liver transplantation (LDLT). Additionally, postoperative outcomes were compared between patients with and without early post-transplant bacteremia. Clinical data of 610 adult patients who underwent elective LDLT between January 2009 and December 2018 at Seoul St. Mary’s Hospital were retrospectively collected. The exclusion criteria included overt signs of infection within 1 month before surgery. A total of 596 adult patients were enrolled in this study. Based on the occurrence of a systemic bacterial infection after surgery, patients were classified into non-infected and infected groups. The incidence of bacteremia at 1 month after LDLT was 9.7% (57 patients) and Enterococcus faecium (31.6%) was the most commonly cultured bacterium in the blood samples. Univariate analysis showed that preoperative psoas muscle index (PMI), model for end-stage disease score, utility of continuous renal replacement therapy (CRRT), ascites, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, and sodium level, as well as intraoperative post-reperfusion syndrome, mean central venous pressure, requirement for packed red blood cells and fresh frozen plasma, hourly fluid infusion and urine output, and short-term postoperative early allograft dysfunction (EAD) were associated with the risk of early post-transplant bacteremia. Multivariate analysis revealed that PMI, the CRRT requirement, the NLR, and EAD were independently associated with the risk of early post-transplant bacteremia (area under the curve: 0.707; 95% confidence interval: 0.667–0.745; p < 0.001). The overall survival rate was better in the non-infected patient group. Among patients with bacteremia, anti-bacterial treatment was unable to resolve infection in 34 patients, resulting in an increased risk of patient mortality. Among the factors included in the model, EAD was significantly correlated with non-resolving infection. We propose a prognostic model to identify patients at high risk for a bloodstream bacterial infection; furthermore, our findings support the notion that skeletal muscle depletion, CRRT requirement, systemic inflammatory response, and delayed liver graft function are associated with a pathogenic vulnerability in cirrhotic patients who undergo LDLT.

中文翻译：

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活体供肝移植后早期菌血症的风险分层：一项回顾性观察队列研究。

这项研究调查了活体供体肝移植（LDLT）患者早期移植后菌血症的围手术期临床危险因素。此外，比较了有无早期移植后菌血症的患者的术后结局。回顾性收集2009年1月至2018年12月在首尔圣玛丽医院接受择期LDLT治疗的610名成年患者的临床数据。排除标准包括手术前1个月内明显的感染迹象。本研究共纳入596名成年患者。根据手术后全身细菌感染的发生，将患者分为未感染组和感染组。LDLT后1个月的菌血症发生率为9.7％（57例）和粪肠球菌（31例）。6％）是血液样本中最常培养的细菌。单因素分析显示术前腰肌指数（PMI），终末期疾病评分模型，连续性肾脏替代疗法（CRRT）的实用性，腹水，C反应蛋白与白蛋白的比率，中性白细胞与淋巴细胞的比率（NLR），血小板淋巴细胞比率和钠水平，以及术中再灌注综合征，平均中心静脉压，对红细胞和新鲜冰冻血浆的需求量，每小时输液量和尿量以及短期术后早期同种异体移植功能障碍（EAD）与早期移植后菌血症的风险有关。多变量分析显示，PMI，CRRT需求，NLR和EAD与移植后早期菌血症的风险独立相关（曲线下面积：0.707; 95％置信区间：0.667–0.745；p <0.001）。未感染患者组的总生存率更好。在有菌血症的患者中，抗菌治疗无法解决34位患者的感染，从而增加了患者死亡的风险。在模型中包括的因素中，EAD与非解决性感染显着相关。我们提出了一种预后模型，以识别高风险的血液细菌感染患者。此外，我们的发现支持以下观点：骨骼肌耗竭，CRRT需求，全身炎症反应和肝移植功能延迟与进行LDLT的肝硬化患者的致病性易感性有关。未感染患者组的总生存率更好。在有菌血症的患者中，抗菌治疗无法解决34位患者的感染，从而增加了患者死亡的风险。在模型中包括的因素中，EAD与非解决性感染显着相关。我们提出了一种预后模型，以识别高风险的血液细菌感染患者。此外，我们的发现支持以下观点：骨骼肌耗竭，CRRT需求，全身炎症反应和肝移植功能延迟与进行LDLT的肝硬化患者的致病性易感性有关。未感染患者组的总生存率更好。在有菌血症的患者中，抗菌治疗无法解决34位患者的感染，从而增加了患者死亡的风险。在模型中包括的因素中，EAD与非解决性感染显着相关。我们提出了一种预后模型，以识别高风险的血液细菌感染患者。此外，我们的发现支持以下观点：骨骼肌耗竭，CRRT需求，全身炎症反应和肝移植功能延迟与进行LDLT的肝硬化患者的致病性易感性有关。在模型中包括的因素中，EAD与非解决性感染显着相关。我们提出了一种预后模型，以识别高风险的血液细菌感染患者。此外，我们的发现支持以下观点：骨骼肌耗竭，CRRT需求，全身炎症反应和肝移植功能延迟与进行LDLT的肝硬化患者的致病性易感性有关。在模型中包括的因素中，EAD与非解决性感染显着相关。我们提出了一种预后模型，以识别高风险的血液细菌感染患者。此外，我们的发现支持以下观点：在接受LDLT的肝硬化患者中，骨骼肌耗竭，CRRT需求，全身炎症反应和肝移植功能延迟与致病性易感性相关。