Objective: To analyze risk factors related to infection during early postoperative period after orthotopic liver transplantation in adults.
Methods: Retrospective study of 400 cases of orthotopic liver transplantation in adults performed between 2003 and 2004. Pre-, intra- and postoperative variables of recipients were analyzed in two groups according to whether or not infection developed.
Results: Infection developed in 121 patients (30.3%). Bacterial infections were most common, accounting for 62.0% (75/121 cases), followed by fungal infection with the percentage of 20.6% (25/121 cases), and virus infection accounting for 12.4% (15/121 cases). The common infection sites were lung (63 cases, 52.1%), gallbladder (23 cases, 19.0%), peritoneal cavity (22 cases, 18.2%), and venous catheter (13 cases, 10.7%). Significant risk factors for infection as shown by the multivariate analysis were acute renal failure, graft dysfunction, acute lung injury, postoperative bleeding, pulmonary edema, history of diabetes mellitus or new onset diabetes mellitus, Child-Pugh stage>10, age>60.
Conclusion: Early postoperative infection after orthotopic liver transplantation in adults is a common and serious complication that continues to be difficult to control. Certain risk factors can be improved with careful management such as acute kidney failure and graft dysfunction. Appropriate anti-infection remedy is very important to prevent drug resistance. However, immunosuppression agents acts as a real predisposing factor of infection with regard to both its development and its clinical manifestation.