204 Surgical Site Infections after Living Donor Liver Transplantation in Egypt

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Amani A. El Kholy, MD , Cairo University, Cairo, Egypt
Ashraf O. Abdelaziz, MD , Cairo University, Cairo, Egypt
Ayman Yosry, MD , Cairo University, Cairo, Egypt
Ahmed Ghaly, MD , Ain Shams University, Cairo, Egypt
Adel El Ansary, MD , Ain Shams University, Cairo, Egypt
Gamal Esmat, MD , Cairo University, Cairo, Egypt
Magdy El Serafy , Cairo University, Cairo, Egypt
Adel Hosny, MD , Cairo University, Cairo, Egypt
Wahid Doss, MD , Cairo University, Cairo, Egypt
Background: Living donor liver transplantation (LDLT) is a successful therapy for patients with end-stage liver disease. Infection is currently a life-threatening complication for these patients. 

Objective: To determine the incidence of surgical site infections (SSI) in patients within the 1st month postoperative period after LDLT and to identify the causative pathogens. 

Methods: The study included 128 LDLTs performed in 128 recipients from October 2001 to January 2007; those patients were followed up for one month after liver transplantation operation by daily clinical rounds and collection of clinical, radiological, imaging and microbiology results. 

Results: The age of the recipients of LDLT ranged between 2 and 64 years (mean 47.3±10.5), 120 recipients were males (M:F=15:1). All the donors were adults (age range=20-47 years, mean=28.7±6.1) and 78.9% of them were males. Among the total, 53.1% of patients developed infection during early postoperative period; 40.6% had bacterial infections (BI); 7% had fungal infections (FI) and 5% CMV. The incidence of superficial and deep SSI was 14.8%. The incidences of intra-abdominal and biliary infections were 28.9% and 14.8% respectively. Gram- negative bacilli were the predominant pathogens constituting 64.1% of bacterial isolates. The most commonly isolated pathogens were E.coli followed by Enterococcus spp. and Methicillin sensitive S.aureus (11.7% each). Multivariate analyses identified the following risk factors for infections: spontaneous bacterial peritonitis (SBP), plural effusion, MELD score, preoperative bilirubin level, long usage of indwelling devices (central venous (CV) and urinary catheters), long ICU and hospital stay, operation time, reoperation, raised immunosuppressive level and frequent pulse steroids. 

Conclusions: SSI is a common complication after LDLT. Infection prevention measures should target the modifiable risk factors such as decreasing the duration of ICU stay and days of utilization of CV and urinary catheters.