Clinical Characteristics of Infections and Death Risk Predictors in Older Recipients (Age 65 Years and Older) After Liver Transplant.

OBJECTIVES

In this study, we analyzed the clinical characteristics of infections and death risk predictors in older recipients (>65 years old) after liver transplant.

MATERIALS AND

METHODS

We conducted a retrospective analysis of 34 older recipients after liver transplant and analyzed the composition and distribution of pathogens, drug resistance, and death risk predictors of infection.

RESULTS

Among 34 patients, 17 (50%) developed postoperative infections; bacterial and fungal infections mainly occurred within 30 days after surgery. Respiratory and biliary tract were common infection sites. Gram-negative bacteria were more common than gram-positive bacteria (63.5% vs 36.5%, respectively), and Klebsiella pneumoniae and Enterococcus faecium ranked as the top 2 pathogens. Klebsiella pneumoniae exhibited high levels of drug resistance, with varying carbapenemase profiles, and maintained relatively good susceptibility (>50%) only to tigecycline, ceftazidime-avibactam, and polymyxin; all E faecium isolates were sensitive to vancomycin. Infection-related deaths occurred in 4 cases, accounting for 80% of total mortality. Postoperative septic shock was identified as a risk factor for all-cause 1-year mortality after liver transplant in older patients.

CONCLUSIONS

Postoperative infection in older liver transplant recipients was characterized by high incidence, high drug resistance, and high infection-related mortality. The main type of gram-negative bacteria was K pneumoniae, which was highly drug-resistant and difficult to treat. Postoperative septic shock was a death risk predictor. Early identification and optimized treatment of postoperative infections and secondary septic shock are crucial for reduction of all-cause 1-year mortality.