Analysis of early infection and bacterial drug resistance in liver transplant patients from organ donation after death

doi:10.3877/cma.j.issn.2095-3232.2019.06.010

Abstract

Abstract:

Objective

To investigate the effects of liver grafts from different sources on the early infection and bacterial drug resistance in the recipients after liver transplantation.

Methods

Clinical data of 296 recipients undergoing orthotopic liver transplantation in Dongfang Hospital Affiliated to Xiamen University from January 2009 to December 2017 were retrospectively analyzed. Among them, 216 patients were male and 80 female, aged (49±13) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different sources of liver grafts, the recipients were divided into the standard criteria donor (SCD, n=197) and donation after citizen's death groups (DCD, n=99). Preoperative and intraoperative covariates between two groups were balanced with propensity score matching (PSM). Early postoperative infection and bacterial drug resistance of two groups were analyzed. The rate comparison was performed by using Chi-square test.

Results

After PSM, 89 eligible patients were recruited in each group. The overall infection rate in the DCD group within postoperative2 months was 60%(53/89), significantly higher than 43%(38/89) in the SCD group (χ²=5.059, P<0.05). The abdominal infection rate in the DCD group was 47%(42/89), significantly higher compared with 33% (29/89) in the SCD group (χ²=3.960, P<0.05). The lung infection rates in DCD and SCD groups were 30% (27/89) and 24% (21/89), respectively, where no significant difference was observed (χ²=1.027, P>0.05). Postoperatively, 81 and 66 pathogens were cultured in DCD and SCD groups, respectively. The percentage of bacteria among pathogens in two groups was respectively 81%(66/81) and 86%(57/66). Gram-positive bacteria were the main bacteria. The multidrug resistance rates in DCD and SCD groups were 39%(26/66) and 47%(27/57) , where no significant difference was observed (χ²=1.306, P>0.05).

Conclusions

Compared with liver grafts procured from SCD, the abdominal infection rate increased in patients of DCD liver transplantation, but in the infection rate of multidrug-resistant bacteria and the incidence rate of pulmonary infection do not increase.

Key words: Liver transplantation, Donation after citizen's death, Infection, Multi-drug resistance

Huaxiang Wang, Fengfeng Xu, Ruisheng Ke, Fang Yang, Qiucheng Cai, Jianyong Liu, Xinghua Huang, Yi Jiang. Analysis of early infection and bacterial drug resistance in liver transplant patients from organ donation after death[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(06): 507-511.

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References 22

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指标	PSM匹配前		统计值	P值	PSM匹配后		统计值	P值
指标	SCD组	DCD组	统计值	P值	SCD组	DCD组	统计值	P值
年龄（岁，±s ）	46±11	50±14	t=-2.201	0.065	48±12	50±15	t=-0.808	0.182
男/女（例）	153/44	63/36	χ²=6.575	0.010	56	56	-	1.000
手术时间（h，±s ）	7.1±1.5	6.3±0.9	t=5.737	0.000	6.4±1.0	6.3±0.9	t=0.430	0.240
肝硬化（例）	85	45	χ²=0.142	0.776	32	40	χ²=1.493	0.222
供肝冷缺血时间（h，±s ）	6.3±1.2	6.9±1.3	t=-1.471	0.342	6.4±1.5	6.8±2.0	t=-1.924	0.246
总蛋白（g/L，±s ）	64±12	66±15	t=-1.197	0.013	68±12	66±15	t=0.607	0.062
术中输血量[ml，M（Q_R）]	3 201 (1 910～4 861)	2 983 (1913～4 669)	U=1.916	0.024	3 000 (1 742～4 290)	2 750 (1 857～4 616)	U=0.067	0.659
WBC（×10⁹/L，±s ）	7.9±2.1	9.1±2.9	t=-2.693	0.047	8.4±1.9	8.8±2.2	t=-1.152	0.113
术前应用抗生素（例）	30	25	χ²=4.376	0.036	17	17	-	1.000

指标	PSM匹配前		统计值	P值	PSM匹配后		统计值	P值
指标	SCD组	DCD组	统计值	P值	SCD组	DCD组	统计值	P值
年龄（岁，±s ）	46±11	50±14	t=-2.201	0.065	48±12	50±15	t=-0.808	0.182
男/女（例）	153/44	63/36	χ²=6.575	0.010	56	56	-	1.000
手术时间（h，±s ）	7.1±1.5	6.3±0.9	t=5.737	0.000	6.4±1.0	6.3±0.9	t=0.430	0.240
肝硬化（例）	85	45	χ²=0.142	0.776	32	40	χ²=1.493	0.222
供肝冷缺血时间（h，±s ）	6.3±1.2	6.9±1.3	t=-1.471	0.342	6.4±1.5	6.8±2.0	t=-1.924	0.246
总蛋白（g/L，±s ）	64±12	66±15	t=-1.197	0.013	68±12	66±15	t=0.607	0.062
术中输血量[ml，M（Q_R）]	3 201 (1 910～4 861)	2 983 (1913～4 669)	U=1.916	0.024	3 000 (1 742～4 290)	2 750 (1 857～4 616)	U=0.067	0.659
WBC（×10⁹/L，±s ）	7.9±2.1	9.1±2.9	t=-2.693	0.047	8.4±1.9	8.8±2.2	t=-1.152	0.113
术前应用抗生素（例）	30	25	χ²=4.376	0.036	17	17	-	1.000

感染类型	病原体	DCD组	SCD组
革兰氏阳性菌	屎肠球菌	12	5
	溶血葡萄球菌	9	6
	金黄色葡萄球菌	8	8
	粪肠球菌	7	5
	其它	2	4
	合计	38	29
革兰氏阴性菌	鲍曼不动杆菌	9	7
	铜绿假单胞菌	5	7
	肺炎克雷伯氏菌	5	5
	嗜麦芽黄单胞菌	3	2
	阴沟肠杆菌	2	3
	其它	4	4
	合计	28	28
真菌	白色念珠菌	9	4
	白假丝酵母菌	4	4
	其它	2	1
	合计	15	9
细菌和真菌	?	81	66

感染类型	病原体	DCD组	SCD组
革兰氏阳性菌	屎肠球菌	12	5
	溶血葡萄球菌	9	6
	金黄色葡萄球菌	8	8
	粪肠球菌	7	5
	其它	2	4
	合计	38	29
革兰氏阴性菌	鲍曼不动杆菌	9	7
	铜绿假单胞菌	5	7
	肺炎克雷伯氏菌	5	5
	嗜麦芽黄单胞菌	3	2
	阴沟肠杆菌	2	3
	其它	4	4
	合计	28	28
真菌	白色念珠菌	9	4
	白假丝酵母菌	4	4
	其它	2	1
	合计	15	9
细菌和真菌	?	81	66

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