Infectious complications in living‐donor liver transplant recipients: a 9‐year single‐center experience

Background. Infectious complications following living‐donor liver transplantation (LDLT) remain a major cause of morbidity and mortality. We analyzed the frequency and type of infectious complications according to the post‐transplantation period, and their risk factors with regard to morbidity and mortality. Methods. We retrospectively analyzed 208 subjects who had undergone LDLT during a 9‐year period. Results. The rate of infection was 1.69 per patient during the study period. The predominant infections were intra‐abdominal infections (37.6%), primary bacteremia (17.4%), and pneumonia (14.5%). Within the first post‐transplant month, 140 (39.9%) infections were detected, and catheter‐related coagulase‐negative staphylococci (44) were the most common infectious agents. During the 2–6‐month post‐transplant period, 109 infectious episodes occurred (31.1%), and Enterococcus sp. (n=16) related to biliary infection was the most frequent isolate. After the sixth month, 96 infectious episodes (29%) occurred, and biliary tract‐related Escherichia coli (n=19) was the major causative organism. The overall mortality was 24.5% (51/208); 1‐year survival rate was 88% (196/208). Post‐transplant infection‐related mortality was 52.9% (27/51). Biliary tract complications, such as biliary stenosis or leakage, significantly increased the mortality (P=0.01); however, reoperation (retransplantation or resurgery for biliary tract obstruction/leakage or to control bleeding) significantly reduced the mortality (P=0.01). Conclusions. Our data showed that early catheter removal would mainly aid in reducing infectious complications in the 1‐month post‐transplantation period. Aggressive management, including reoperation, would lower the mortality in the LDLT recipients.