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Living donor LT recipients may have increased surgical site infection risk

In a prospective study, researchers found that adult and pediatric recipients of a living donor liver transplant had an increased risk for developing surgical site infections post-transplant.

Researchers in Japan analyzed data of 129 adult and 72 pediatric living donor liver transplant (LDLT) recipients enrolled at Kyoto University Hospital in Japan from two separate time periods. Of the adult patients, 66 were from April 2001 to March 2002, the first period, and 63 were from January 2011 to June 2012, the second period. Of the pediatric patients, 39 were studied in the first period and 33 were studied in the second.

The researchers sought to determine the epidemiology of surgical site infections (SSIs) after LDLT and any differences between the two periods. All recipients who received an LDLT were followed by two infection control physicians, and all infections from the time of surgery until 30 days after the LDLT were recorded, according to the research.

Among the adult recipients, SSI rates during the first study period were 30.3% (n = 20) and 41.3% (n = 26) during the second study period. Among the pediatric recipients, SSI rates were 25.6% (n = 10) during the first study period and 30.3% (n = 10) during the 2nd study period.

The most common site of infection for both periods of adult and pediatric patients was the organ/space (84.8% and 85%, respectively). The SSI rates of the adult recipients were greater compared with the pediatric recipients in both time periods.

“SSIs after LDLT are a major complication, with an incidence ranging from 30% to 40%,” the researchers wrote.

From the first period to the second period, Enterococcus faecium incidence increased from 5% to 26.9% in adult patients and from 10% to 40% in pediatric patients.

There were no significant differences between the cumulative incidence rates of SSIs after LDLT in the patient populations in either period (P = .3 for adult, P = .72 for pediatric recipients).

Multivariate analysis showed that male recipients (P < .01) and Roux-en-Y biliary reconstruction (P = .04) were independent risk factors for SSIs after LDLT during the 1st period in the adult population. Univariate analysis showed ABO incompatibility (P = .02), longer operation duration (P = .01), lower graft-to-recipient body weight ratio (P = .04) and Roux-en-Y biliary reconstruction (P < .01) to be significantly associated with SSIs after LDLT among the adults.

Univariate analysis showed that age (P = .04) and repeat operation (P = .03) were associated with SSI among the pediatric population in the first period. Additionally, repeat operation was found to be the only independent risk factor (P = .02) during this period. In the second period, age remained a significant risk factor for SSI (P = .01), according to univariate analysis, as well as an independent risk factor (P = .01).

“To improve the SSI rate and the mortality of SSIs, changing only the prophylactic antimicrobials is not sufficient,” the researchers wrote. “The creation of a stricter or more individualized strategy for preventing and managing SSIs, including via prophylaxis and management, is urgently needed.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.