Surgical Site Infections, Risk Factors, and Outcomes After Liver Transplant
Peter W. Schreiber, Linard Hoessly, Katia Boggian, Dionysios Neofytos, Christian van Delden, Adrian Egli, Michael Dickenmann, Cédric Hirzel, Oriol Manuel, Michael Koller, Simona Rossi, Vanessa Banz, Philippe Compagnon, Philipp Dutkowski, Andreas E. Kremer, Annalisa Berzigotti, Julien Vionnet, Nicolas Goossens, David Semela, Patrizia Künzler‐Heule, Christine Bernsmeier, Stefan P. Kuster, Susanne Stampf, Nicolas J. Mueller, Swiss Transplant Cohort Study, Patrizia Amico, Adrian Bachofner, Vanessa Banz, Sonja Beckmann, Guido Beldi, Christoph Berger, Ekaterine Berishvili, Annalisa Berzigotti, Isabelle Binet, Pierre–Yves Bochud, Sanda Branca, Anne Cairoli, Emmanuelle Catana, Yves Chalandon, Sabina De Geest, Sophie de Seigneux, Joëlle Lynn Dreifuss, Michel A. Duchosal, Thomas Fehr, Sylvie Ferrari-Lacraz, Jaromil Frossard, Déla Golshayan, Nicolas Goossens, Fadi Haidar, Dominik Heim, Christoph Hess, Sven Hillinger, Hans H. Hirsch, Patricia Hirt, Linard Hoessly, Günther F.L. Hofbauer, Uyen Huynh‐Do, Nina Khanna, Michael Koller, Andreas E. Kremer, Thorsten Krueger, Christian Kuhn, Bettina Laesser, Frédéric Lamoth, Roger Lehmann, Alexander Leichtle, Oriol Manuel, Hans‐Peter Marti, Michele Martinelli, Valérie A. McLin, Katell Mellac, Aurélia Mercay, Karin Mettler, N Müller, Ulrike Müller-Arndt, Mirjam Nägeli, Graziano Oldani, Manuel Pascual, Rosemarie Pazeller, Klara M. Posfay‐Barbe, David Reineke, Juliane Rick, Simona Rossi, Fabian Rössler, Silvia Rothlin, Frank Ruschitzka, Thomas Schachtner, Stefan Schaub, Dominik Schneidawind, Macé M. Schuurmans, Simon Schwab, Thierry Sengstag, Federico Simonetta, Jürg Steiger, Guido Stirniman, Ueli Stürzinger, Christian Van Delden, Jean-Pierre Venetz, Jean Villard, Julien Vionnet
Abstract
Importance: Surgical site infections (SSIs) are one of the most common health care-associated infections. Surgical site infections can have harmful effects in liver transplant (LT) recipients. Objective: To assess the incidence of SSI after LT and identify risk factors associated with SSIs and whether SSIs are associated with death and graft loss. Design, Setting, and Participants: A multicenter cohort study encompassing data on LT performed at all Swiss transplant centers between May 1, 2008, and September 30, 2020, was conducted. Data analyses were performed in 2023. Exposure: Liver transplant. Main Outcomes and Measures: Frequency of SSIs within 90 days after transplant, risk factors associated with SSIs, and association of SSIs with 1-year death or graft loss. Surgical site infections were defined according to Centers for Disease Control and Prevention criteria with SSIs occurring within 90 days after LT. For association with posttransplant outcomes, 1-year follow-up data were analyzed. Results: Among 1333 LT recipients in the Swiss Transplant Cohort Study, 1158 adults were included in analyses. Median age was 57.2 (IQR, 49.3-62.8) years and 792 were men (68.4%). Seventy patients (6.0%) had an SSI. Most SSIs were deep incisional (9 [12.8%]) or organ-space infections (54 [77.1%]). In most SSIs (56 [80.0%]), bacteria were detected, most frequently Enterococcus spp (36 of 75 [48.0%]) and Escherichia coli (12 of 75 [16.0%]). In multivariable analysis, prior liver transplant (odds ratio [OR] 4.01; 95% CI, 1.44-11.18; P = .008) and living liver donation (OR, 4.08; 95% CI, 1.37-12.16; P = .01) were independent risk factors associated with SSIs. Surgical site infections were independently associated with graft loss and/or death (hazard ratio [HR], 3.24; 95% CI, 1.82-5.79; P < .001); this association was observed in separate analyses on graft loss (HR, 2.97; 95% CI, 1.32-6.68; P = .02) and death (HR, 3.25; 95% CI, 1.44-7.35; P = .01). Conclusions and Relevance: The findings of this study suggest that prior liver transplant and living liver donation are independent risk factors associated with SSIs and that SSIs are independently associated with graft loss and/or death, highlighting the relevance of this health care-associated infection.