Advertisement

Infection

, Volume 47, Issue 1, pp 77–85 | Cite as

Risk factors of bloodstream infections in recipients after liver transplantation: a meta-analysis

  • Qiang He
  • Pin Liu
  • Xuan Li
  • Kewen Su
  • Dan Peng
  • Zhongshuang Zhang
  • Wei Xu
  • Zhen Qin
  • Shuai Chen
  • Yingli LiEmail author
  • Jingfu QiuEmail author
Original Paper
  • 95 Downloads

Abstract

Purpose

Bloodstream infection (BSI) is an important cause of adverse outcomes for recipients with liver transplantation (LT). This meta-analysis aimed to identify risk factors associated with post-LT BSI.

Methods

Relevant studies published up to June 2017 were searched from seven electronic databases. The studies were reviewed according to the inclusion and exclusion criteria. The Z test was used to determine the pooled odds ratio (OR) or standardized mean difference (SMD) of the risk factors. ORs and their corresponding 95% confidence intervals (CIs), or SMDs and their corresponding 95% CIs were used to identify the significant difference of risk factors.

Results

Seventeen studies enrolling 4410 recipients were included. Eleven risk factors were identified to be associated with BSI after LT: male recipient (OR = 1.28), ascites (OR = 1.68), model for end-stage liver disease (MELD) score (SMD = 0.20), Child–Pugh class C (OR = 1.69), operation time (SMD = 0.18), incompatible blood type (OR = 2.87), operative blood loss (SMD = 0.33), rejection (OR = 1.72), biliary complications (OR = 1.91), hemodialysis (OR = 3.37), and retransplantation (OR = 2.86).

Conclusions

Although some risk factors were identified as significant factors for BSI after LT, which may provide a basis for clinical prevention, well-designed prospective studies should be done to overcome the limitations of this study.

Keywords

Bloodstream infection Liver transplantation Risk factors Meta-analysis 

Notes

Funding

This work was supported by the National Natural Science Foundation of China (31200064, 31071093, and 31170129).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Song AT, Avelino-Silva VI, Pecora RA, Pugliese V, D’Albuquerque LA, Abdala E. Liver transplantation: fifty years of experience. World J Gastroenterol. 2014;20:5363–74.CrossRefGoogle Scholar
  2. 2.
    Lee SO, Kang SH, Abdel-Massih RC, Brown RA, Razonable RR. Spectrum of early-onset and late-onset bacteremias after liver transplantation: implications for management. Liver Transpl. 2011;17:733–41.CrossRefGoogle Scholar
  3. 3.
    Santos CA, Hotchkiss RS, Chapman WC, Olsen MA. Epidemiology of bloodstream infections in a multicenter retrospective cohort of liver transplant recipients. Transpl Direct. 2016;2:e67.CrossRefGoogle Scholar
  4. 4.
    Shao M, Wan Q, Xie W, Ye Q. Bloodstream infections among solid organ transplant recipients: epidemiology, microbiology, associated risk factors for morbility and mortality. Transpl Rev (Orlando Fla). 2014;28:176–81.CrossRefGoogle Scholar
  5. 5.
    Wagener MM, Yu VL. Bacteremia in transplant recipients: a prospective study of demographics, etiologic agents, risk factors, and outcomes. Am J Infect Control. 1992;20:239–47.CrossRefGoogle Scholar
  6. 6.
    Hsu J, Andes DR, Knasinski V, Pirsch J, Safdar N. Statins are associated with improved outcomes of bloodstream infection in solid-organ transplant recipients. Eur J Clin Microbiol Infect Dis. 2009;28:1343–51.CrossRefGoogle Scholar
  7. 7.
    Sganga G, Spanu T, Bianco G, Fiori B, Nure E, Pepe G, et al. Bacterial bloodstream infections in liver transplantation: etiologic agents and antimicrobial susceptibility profiles. Transpl Proc. 2012;44:1973–6.CrossRefGoogle Scholar
  8. 8.
    Kalpoe JS, Sonnenberg E, Factor SH, del Rio Martin J, Schiano T, Patel G, et al. Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl. 2012;18:468–74.CrossRefGoogle Scholar
  9. 9.
    Wan QQ, Ye QF, Ming YZ, Ma Y, Zhou JD, Qiao BB, et al. The risk factors for mortality in deceased donor liver transplant recipients with bloodstream infections. Transpl Proc. 2013;45:305–7.CrossRefGoogle Scholar
  10. 10.
    Kritikos A, Manuel O. Bloodstream infections after solid-organ transplantation. Virulence. 2016;7:329–40.CrossRefGoogle Scholar
  11. 11.
    Singh N, Gayowski T, Wagener MM, Marino I. Bloodstream infections in liver transplant recipients receiving tacrolimus. Clin Transpl. 1997;11:275–81.Google Scholar
  12. 12.
    Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305–9.CrossRefGoogle Scholar
  13. 13.
    van Hoek B, de Rooij BJ, Verspaget HW. Risk factors for infection after liver transplantation. Best Pract Res Clin Gastroenterol. 2012;26:61–72.CrossRefGoogle Scholar
  14. 14.
    Avkan-Oguz V, Ozkardesler S, Unek T, Ozbilgin M, Akan M, Firuzan E, et al. Risk factors for early bacterial infections in liver transplantation. Transpl Proc. 2013;45:993–7.CrossRefGoogle Scholar
  15. 15.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40.CrossRefGoogle Scholar
  16. 16.
    Margulis AV, Pladevall M, Riera-Guardia N, Varas-Lorenzo C, Hazell L, Berkman ND, et al. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle–Ottawa Scale and the RTI item bank. J Clin Epidemiol. 2014;6:359–68.CrossRefGoogle Scholar
  17. 17.
    Tai Q, Wu WL, Ju WQ, Wang DP, Wang GD, Ma Y, et al. A 17-year retrospective study of the risk factor of bloodstream infection with MRSA after liver transplantation. J Trop Med 2011:1141–3.Google Scholar
  18. 18.
    Bedini A, Codeluppi M, Cocchi S, Guaraldi G, Di Benedetto F, Venturelli C, et al. Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival. Transpl Proc. 2007;39:1947–9.CrossRefGoogle Scholar
  19. 19.
    Bert F, Larroque B, Paugam-Burtz C, Janny S, Durand F, Dondero F, et al. Microbial epidemiology and outcome of bloodstream infections in liver transplant recipients: an analysis of 259 episodes. Liver Transpl. 2010;16:393–401.Google Scholar
  20. 20.
    Karvellas CJ, McPhail M, Pink F, Asthana S, Muiesan P, Heaton N, et al. Bloodstream infection after elective liver transplantation is associated with increased mortality in patients with cirrhosis. J Crit Care. 2011;26:468–74.CrossRefGoogle Scholar
  21. 21.
    Hashimoto M, Sugawara Y, Tamura S, Kaneko J, Matsui Y, Togashi J, et al. Bloodstream infection after living donor liver transplantation. Scand J Infect Dis. 2008;40:509–16.CrossRefGoogle Scholar
  22. 22.
    Iida T, Kaido T, Yagi S, Yoshizawa A, Hata K, Mizumoto M, et al. Posttransplant bacteremia in adult living donor liver transplant recipients. Liver Transpl. 2010;16:1379–85.CrossRefGoogle Scholar
  23. 23.
    Iinuma Y, Senda K, Fujihara N, Saito T, Takakura S, Kudo T, et al. Surgical site infection in living-donor liver transplant recipients: a prospective study. Transplantation. 2004;78:704–9.CrossRefGoogle Scholar
  24. 24.
    Ikegami T, Shirabe K, Yoshiya S, Yoshizumi T, Ninomiya M, Uchiyama H, et al. Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition. J Am Coll Surg. 2012;214:288–95.CrossRefGoogle Scholar
  25. 25.
    Kim HK, Park YK, Wang HJ, Kim BW, Shin SY, Lim SK, et al. Epidemiology and clinical features of post-transplant bloodstream infection: an analysis of 222 consecutive liver transplant recipients. J Infect Chemother. 2013;45:315–24.CrossRefGoogle Scholar
  26. 26.
    Kim SI, Kim YJ, Jun YH, Wie SH, Kim YR, Choi JY, et al. Epidemiology and risk factors for bacteremia in 144 consecutive living-donor liver transplant recipients. Yonsei Med J. 2009;50:112–21.CrossRefGoogle Scholar
  27. 27.
    Munoz-Price LS, Slifkin M, Ruthazer R, Poutsiaka DD, Hadley S, Freeman R, et al. The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients. Clin Infect Dis. 2004;39:1293–9.CrossRefGoogle Scholar
  28. 28.
    Oweira H, Lahdou I, Daniel V, Hofer S, Mieth M, Schmidt J, et al. Early post-transplant neopterin associated with one year survival and bacteremia in liver transplant recipients. Hum Immunol. 2016;77:115–20.CrossRefGoogle Scholar
  29. 29.
    Rhee KW, Oh SH, Kim KM, Kim DY, Lee YJ, Kim T, et al. Early bloodstream infection after pediatric living donor living transplantation. Transpl Proc. 2012;44:794–6.CrossRefGoogle Scholar
  30. 30.
    Shi SH, Kong HS, Jia CK, Xu J, Zhang WJ, Wang WL, et al. Coagulase-negative staphylococcus and enterococcus as predominant pathogens in liver transplant recipients with Gram-positive coccal bacteremia. Chin Med J (Engl). 2010;123:1983–8.Google Scholar
  31. 31.
    Shimizu S, Tanaka Y, Tazawa H, Verma S, Onoe T, Ishiyama K, et al. Fc-gamma receptor polymorphisms predispose patients to infectious complications after liver transplantation. Am J Transpl. 2016;16:625–33.CrossRefGoogle Scholar
  32. 32.
    Shoji K, Funaki T, Kasahara M, Sakamoto S, Fukuda A, Vaida F, et al. Risk factors for bloodstream infection after living-donor liver transplantation in children. Pediatr Infect Dis J. 2015;34:1063–8.CrossRefGoogle Scholar
  33. 33.
    Takeda K, Sawada Y, Kumamoto T, Tanaka K, Endo I. Severe sepsis after living donor liver transplantation: risk factors and outcomes. Transpl Proc. 2016;48:2124–9.CrossRefGoogle Scholar
  34. 34.
    Banff Working G, Demetris AJ, Adeyi O, Bellamy CO, Clouston A, Charlotte F, et al. Liver biopsy interpretation for causes of late liver allograft dysfunction. Hepatology. 2006;44:489–501.CrossRefGoogle Scholar
  35. 35.
    Yan HM, Ji SH, Chen HR, Wang HX, Zhu PY, Xue M, et al. Immune-reconstitution following HLA haplotype related T-cell undepleted allogeneic bone marrow transplantation. J Clin Hematol. 2005;18:7–10.Google Scholar
  36. 36.
    Genda T, Ichida T, Sakisaka S, Tanaka E, Mochida S, Ueno Y, et al. Survival in patients with Child-Pugh class C cirrhosis: analysis of the liver transplant registry in Japan. Hepatol Res. 2017;47:1155–64.CrossRefGoogle Scholar
  37. 37.
    Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–71.CrossRefGoogle Scholar
  38. 38.
    Peng Y, Qi XS, Dai JN, Li HY, Guo XZ. Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis. Int J Clin Exp Med. 2015;8:751–7.Google Scholar
  39. 39.
    Tischer S, Miller JT. Pharmacologic strategies to prevent blood loss and transfusion in orthotopic liver transplantation. Crit Care Nurs Q. 2016;39:267–80.CrossRefGoogle Scholar
  40. 40.
    Mor E, Jennings L, Gonwa TA, Holman MJ, Gibbs J, Solomon H, et al. The impact of operative bleeding on outcome in transplantation of the liver. Surg Gynecol Obstet. 1993;176:219–27.Google Scholar
  41. 41.
    Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World J Gastroenterol. 2013;19:2841–6.CrossRefGoogle Scholar
  42. 42.
    Nadim MK, Annanthapanyasut W, Matsuoka L, Appachu K, Boyajian M, Ji L, et al. Intraoperative hemodialysis during liver transplantation: a decade of experience. Liver Transpl. 2014;20:756–64.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Qiang He
    • 1
  • Pin Liu
    • 1
  • Xuan Li
    • 1
  • Kewen Su
    • 1
  • Dan Peng
    • 1
  • Zhongshuang Zhang
    • 1
  • Wei Xu
    • 1
  • Zhen Qin
    • 1
  • Shuai Chen
    • 1
  • Yingli Li
    • 1
    Email author
  • Jingfu Qiu
    • 1
    Email author
  1. 1.School of Public Health and ManagementChongqing Medical UniversityChongqingChina

Personalised recommendations