Preoperative Infection Within a Month is Associated With Inferior Posttransplant Outcomes in Adult Living Donor Liver Transplants.

BACKGROUND

Preoperative infection is a major determinant of outcome following liver transplant. The current study aims to assess the impact of preoperative infection on posttransplant outcomes following adult living donor liver transplantation (LDLT).

METHODS

LDLT recipients (n = 578; retrospective cohort: 452, prospective cohort: 126) were divided into group 1 (pre-PDLT infection within 15 days), group 2 (15-30 days), group 3 (30-90 days), group 4 (>90 days), and group 5 (without documented infection). The impact of timelines of pretransplant infections on posttransplant sepsis-related outcomes and mortality were analyzed.

RESULTS

The groups 1, 2, 3, 4, and 5 comprised 104(18%), 35(6%), 44(8%), 222(38%), and 173(30%) recipients, respectively. Posttransplant sepsis and septic shock were seen in 278(48%) and 133(23%) patients, respectively. Three-month mortality was 12.1% (70/578) and 55.7% of them had mortality attributed to sepsis. Group 1 and 2 recipients experienced higher three-month overall and sepsis-related mortality [25.17% vs 8%; odds ratio (OR):3.87(2.31-6.47); P = 0.04] and [80% vs 31.42%; OR: 8.73(2.92-26.04); P=<0.001], respectively, compared to the other groups. With an upper limit of three-month mortality kept at 10%, receiver operating characteristic curve showed minimum pretransplant 'infection-free interval' of 27days (Area Under Curve = 0.780). Multivariate analysis revealed pre-LDLT infection within 27 days [OR :3.61(2.83-4.44)], pre-LDLT infection with multidrug-resistant (MDR)/extensively drug-resistant (XDR) organisms [OR :4.8 (1.6-14.9)], MELD >25 [OR :2.51 (1.09-5.79)], and biliary/vascular complications [OR :1.82 (1.10-2.74)] predicted three-month mortality.

CONCLUSION

Infection within one month before LDLT is associated with high overall and sepsis-related three-month mortality. Preoperative infection within 27 days and MDR/XDR infections, MELD-Na >25, and post-LDLT biliary/vascular complications predicted mortality.

TRIAL REGISTRATION: Present RCT was registered at ClinicalTrials.gov (NCT05109156).