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Surgical site infection in liver transplant recipients in the MELD era Analysis of the epidemiology, risk factors, and outcomes

Surgical site infection in liver transplant recipients in the MELD era Analysis of the epidemiology, risk factors, and outcomes

In liver transplant (LT) recipients, one of the most common types of infection occurring in the first 60 days after LT is surgical site infection (SSI). In 2007, the model for end-stage liver disease (MELD) scoring system was adopted as the basis for prioritizing organ allocation. Patients with higher MELD scores are at a higher risk of developing SSI, as well as other healthcare-associated infections. However, there have been no studies comparing SSI incidence in the pre-MELD era with that in the period since its adoption. Therefore, the objective of this study was to evaluate the incidence, etiology, epidemiology, and outcomes of post-LT SSI in those two periods, as well as to identify risk factors for SSI. We evaluated all patients who underwent LT over a ten-year period (2002-2011). Cases of SSI were identified through active surveillance. The primary outcome measure was SSI during the first 60 days after LT. Risk factors were analyzed by logistic regression, and 60-day survival rates were evaluated by Cox regression. We evaluated 543 patients who underwent 597 LTs. The SSI rate in the 2002-2006 and 2007-2011 periods was 30% and 24%, respectively (P = 0.21). We identified the following risk factors for SSI: retransplantation; transfusion of more than two units of blood during LT; dialysis; cold ischemia for > 400 minutes; and cytomegalovirus infection. The overall 60-day survival rate was 79%. Risks factors for 60-day mortality were retransplantation, dialysis, and longer surgical time. The use of the MELD score modified the incidence and epidemiology of SSI only during the first year after its adoption. Risks for SSI were more related to intra-operative conditions and intercurrences on post-LT than to pre-LT patient status. Liver Transpl , 2013.

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Accession: 036925655

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DOI: 10.1002/lt.23682

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