Abstract
BACKGROUND: Preoperative infection is a major determinant of outcome following liver transplant. The current study aims to assess the impact of preoperative infection on posttransplant outcomes following adult living donor liver transplantation (LDLT). METHODS: LDLT recipients (n = 578; retrospective cohort: 452, prospective cohort: 126) were divided into group 1 (pre-PDLT infection within 15 days), group 2 (15-30 days), group 3 (30-90 days), group 4 (>90 days), and group 5 (without documented infection). The impact of timelines of pretransplant infections on posttransplant sepsis-related outcomes and mortality were analyzed. RESULTS: The groups 1, 2, 3, 4, and 5 comprised 104(18%), 35(6%), 44(8%), 222(38%), and 173(30%) recipients, respectively. Posttransplant sepsis and septic shock were seen in 278(48%) and 133(23%) patients, respectively. Three-month mortality was 12.1% (70/578) and 55.7% of them had mortality attributed to sepsis. Group 1 and 2 recipients experienced higher three-month overall and sepsis-related mortality [25.17% vs 8%; odds ratio (OR):3.87(2.31-6.47); P = 0.04] and [80% vs 31.42%; OR: 8.73(2.92-26.04); P=<0.001], respectively, compared to the other groups. With an upper limit of three-month mortality kept at 10%, receiver operating characteristic curve showed minimum pretransplant 'infection-free interval' of 27days (Area Under Curve = 0.780). Multivariate analysis revealed pre-LDLT infection within 27 days [OR :3.61(2.83-4.44)], pre-LDLT infection with multidrug-resistant (MDR)/extensively drug-resistant (XDR) organisms [OR :4.8 (1.6-14.9)], MELD >25 [OR :2.51 (1.09-5.79)], and biliary/vascular complications [OR :1.82 (1.10-2.74)] predicted three-month mortality. CONCLUSION: Infection within one month before LDLT is associated with high overall and sepsis-related three-month mortality. Preoperative infection within 27 days and MDR/XDR infections, MELD-Na >25, and post-LDLT biliary/vascular complications predicted mortality. TRIAL REGISTRATION: Present RCT was registered at ClinicalTrials.gov (NCT05109156).