Posttransplant Bacteremia in Adult Living Donor Liver Transplant Recipients
Posttransplant Bacteremia in Adult Living Donor Liver Transplant Recipients
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DOI：
10.1002/lt.22165
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发表时间：
2010-12-01
影响因子：
4.6
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Iida, Taku;Kaido, Toshimi;Uemoto, Shinji
活体供肝移植（LDLT）后的感染性并发症如菌血症与显著的发病率和死亡率相关。我们回顾性分析了2006年4月至2009年11月181例成年LDLT受者移植后菌血症的频率和特征，并评估了移植后菌血症的危险因素。181例受者中有62例（34.3%）在移植后12天（范围= 1-71天）内发生117例菌血症。最常见的病原菌为铜绿假单胞菌（26例）、耐甲氧西林凝固酶阴性葡萄球菌（22例）和肠球菌（11例）。菌血症患者（n = 62）的1年总生存率显著低于无菌血症患者（n = 119； 69.6%对92.3%,P < 0.0001）。多因素分析显示Child-Pugh C级（P = 0.0002）、术前大量胸腔积液或需要引流的腹水（P = 0.0384）、术后巨细胞病毒感染（P = 0.0014）、ABO血型不合（P = 0.0188）、供体年龄较大（P = 0.015）是术后菌血症的独立危险因素。综上所述，成人LDLT后菌血症发生率高，并导致其患者较高的死亡率。感染控制可能在改善LDLT术后早期预后方面发挥关键作用。中华肝病杂志，2010(4):379- 385。(c) 2010年。
Infectious complications such as bacteremia after living donor liver transplantation (LDLT) are associated with significant morbidity and mortality. We retrospectively analyzed the frequency and characteristics of posttransplant bacteremia in 181 adult LDLT recipients between April 2006 and November 2009, and we evaluated the risk factors for posttransplant bacteremia. One hundred seventeen episodes of bacteremia occurred in 62 of 181 recipients (34.3%) within 12 days (median) after transplantation (range = 1-71 days). The most frequently isolated pathogens were Pseudomonas aeruginosa (26 episodes), methicillin-resistant coagulase-negative staphylococci (22 episodes), and Enterococcus sp. (11 episodes). The overall survival rate at 1 year for patients with bacteremia (n = 62) was significantly lower than the rate for patients without bacteremia (n = 119; 69.6% versus 92.3%, respectively, P < 0.0001). Multivariate analysis showed that Child-Pugh class C (P = 0.0002), preoperative massive pleural effusion or ascites requiring drainage (P = 0.0384), postoperative cytomegalovirus infection (P = 0.0014), ABO incompatibility (P = 0.0188), and older donor age (P = 0.015) were independent risk factors for postoperative bacteremia. In conclusion, bacteremia occurred at a high rate after adult LDLT and induced a higher mortality rate in those who developed it. Infection control may play a pivotal role in improving early outcomes after LDLT. Liver Transpl 16:1379-1385, 2010. (C) 2010 AASLD.