Infectious complications as prognostic factors for negative outcomes of liver transplantation

Abstract

Aim . To study the influence of infectious complications on the outcomes of orthotopic liver transplantation. Materials and methods . The methodology involved analyzing the outcomes of 159 orthotopic transplantations of full postmortem liver for 2013–2022. Surgical complications were classified according to Clavien-Dindo (2004). Special attention was paid to microbiological examination of biological fluids with determination of the pathogen species and susceptibility to antimicrobial agents. Determination of isolated cultures and sensitivity to antibacterial agents was carried out using automatic analyzers. Sensitivity and resistance to antimicrobials were determined according to the recommendations of the European Committee (EUCAST, www.eucast.org). Results . At present, 78 of 141 recipients are alive. After discharge, 42 died of various causes within 4–124 months. In-hospital mortality was 9.9% after primary liver transplantations and 38.9% after retransplantations. Recently, K. pneumoniae (18.8%), E. coli (18.7%), C. albicans (9.7%) have dominated the pathogen spectrum. In microbiological examination, after primary transplantation, pathogens were more often isolated from the wound discharge, after retransplantation – from the biliary system. Conclusion . Infectious complications remain a significant cause of unsatisfactory outcomes of liver transplantation. The greatest negative prognostic role belongs to biliary infection caused by multidrug-resistant pathogens in combination with insufficient arterial blood supply of the transplant.