Impact of bacterial infections prior to liver transplantation on post-transplant outcomes in patients with cirrhosis
Simone Incicco, Marta Tonon, N. Zeni, Carmine Gambino, Roberta Gagliardi, Valeria Calvino, Anna Barone, Gianluca Zilio, Paolo Feltracco, Patrizia Burra, Umberto Cillo, Paolo Angeli, Salvatore Piano
Abstract
Background and aimsBacterial infections (BI) are frequent in patients with cirrhosis and increase the risk of death and drop-out from liver transplant (LT) waiting list. In patients with BI, LT is frequently delayed due to the fear of poor outcomes. We evaluated the impact of pre-LT infections on post-LT complications and survival.Methodsfrom 2012 to 2018 consecutive patients transplanted at the Hospital of Padua were identified and classified in two groups: patients surviving an episode of BI within three months prior LT (study group) and patients without infections prior LT (control group). Post-LT outcomes (complications, new infections, survival) were collected.Results466 LT recipients were identified (study group n=108; control group n=358). After LT, study group had a higher incidence of new bacterial (57% vs 20%, p<0.001) and fungal infections (14% vs 5%, p=0.001) and of septic shock (8% vs 2%, p=0.004) than control group. Along with MELD score, and alcohol-related cirrhosis, BI pre-LT was an independent predictor of post-LT infections (OR=3.92; p<0.001). Nevertheless, no significant difference was found in one-year (88% vs 89%, p=0.579) and five-year survival rates (76% vs 75%, p=0.829) between study group and control group. Within study group, no association was found between the time elapsed from infection improvement/resolution to LT and post-LT outcomes.ConclusionsPatients with pre-LT infections have higher risk of new bacterial and fungal infections and of septic shock after LT. However, post-LT survival is excellent. Therefore, as soon as BI is improving/resolving, transplant should not be delayed, but patients with pre-transplant BI require an active surveillance for infections after LT.Impact and implicationsBacterial infections increase mortality and delay transplant in patients with cirrhosis awaiting liver transplantation (LT). Little is known about the impact of adequately treated infections before LT on post-transplant complications and outcomes. The study highlights that pre-LT infections increase the risk of post-LT infections, but post-LT survival rates are excellent despite the risk. These findings suggest that physicians should not delay LT due to concerns about pre-LT infections, but instead should actively monitor these patients for infections after surgery.