Kim et al reported factors associated with a poor outcome for a living donor transplant recipient with an early recurrent bloodstream infection. The authors are from Sungkyunkwan University and Inje University in South Korea.
Patient selection: living donor liver transplant recipient with early recurrent bloodstream infection.
Early bloodstream infection: within 2 months after transplant.
Recurrent early bloodstream infection - one of the following, with negative blood cultures in the interval:
(1) infection with another organism after a >= 48-hour interval
(2) relapse with the same organism after a >= 7-day interval
Frequency of recurrent bloodstream infection: 26%
Outcomes: all-cause mortality at 90 days and 1 year after the transplant
Predictors of 1-year all-cause mortality:
(1) early recurrent bloodstream infection (HR 5.3)
(2) pre-transplant ICU stay (aHR 2.2)
(3) intra-abdominal and/or biliary complications (IABC, aHR 2.2)
(4) diabetes mellitus (aHR 1.6)
(5) acute rejection (aHR 2.3)
HBV infection was associated with lower risk for 90-day and 1-year mortality.
Predictors of early recurrent bloodstream infection:
(1) intra-abdominal and/or biliary complications (aOR 40.1)
(2) early allograft dysfunction (aOR 2.7)
(3) longer cold ischemic time >= 89 minutes (aOR 3.1)
(4) longer recipient operative time > 625 minutes (aOR 3.4)
(5) pre-transplant ICU stay (AOR 4.3)
1-year survival was 92% with no bloodstream infection, 81% with 1 episode and 29% if recurrent.
