PURPOSE: Bacteremia is a major infectious complication associated with mortality in liver transplant recipients. The causative organisms and clinical courses differ between medical centers due to variations in regional bacterial epidemiology and posttransplant care. Further, living donors in Korea contribute to 83% of liver transplants, and individualized data are required to improve survival rates. PATIENTS AND METHODS: We retrospectively analyzed 104 subjects who had undergone living-donor liver transplant from 2005 to 2007. RESULTS: Among the 144 consecutive living-donor liver transplant recipients, 24% (34/144) developed bacteremia, 32% (46/144) developed non-bacteremic infections, and 44% (64/144) did not develop any infectious complications. Forty episodes of bacteremia occurred in 34 recipients. The major sources of bacteremia were intravascular catheter (30%; 12/40), biliary tract (30%; 12/40), and abdomen (22.5%; 9/40). Gram-positive cocci were more common (57.5%; 23/40) than Gram-negative rods (32.5 %; 13/40) and fungi (10%; 4/40). The data revealed that the following factors were significantly different between the bacteremia, non-bacteremic infection, and no infection groups: age (p = 0.024), posttransplant hemodialysis (p = 0.002), ICU stay (p = 0.012), posttransplant hospitalization (p < 0.0001), and duration of catheterization (p < 0.0001). The risk factors for bacteremia were older than 55 years (odds ratio, 6.1; p = 0.003), catheterization for more than 22 days (odds ratio, 4.0; p = 0.009), UNOS class IIA (odds ratio, 6.6; p = 0.039), and posttransplant hemodialysis (odds ratio, 23.1; p = 0.001). One-year survival rates in the bacteremic, non-bacteremic infection, and no infection groups were 73.2%, 91.3%, and 93.5%, respectively. CONCLUSION: Early catheter removal and preservation of renal function should focus for improving survival after transplant.
Adult ; Bacteremia/etiology/*mortality ; Catheterization/adverse effects/statistics & numerical data ; Female ; Humans ; Korea/epidemiology ; Liver Transplantation/*mortality/statistics & numerical data ; Living Donors ; Male ; Middle Aged ; Postoperative Complications/etiology/*mortality ; Predictive Value of Tests ; Risk Factors ; Survival Analysis

Liver transplantation (LT) has been the key therapy for end stage liver diseases. However, LT in infancy is still understudied. From 1992 to 2010, 152 children had undergone LT in Seoul National University Hospital. Operations were performed on 43 patients aged less than 12 months (Group A) and 109 patients aged over 12 months (Group B). The mean age of the recipients was 7 months in Group A and 74 months in Group B. The patients' survival rates and post-LT complications were analyzed. The mean Pediatric End-stage Liver Disease score was higher in Group A (21.8) than in Group B (13.4) (P = 0.049). Fulminant hepatitis was less common in Group A (4.8%) than in Group B (13.8%) (P = 0.021). The post-transplant lymphoproliferative disorder and portal vein complication were more common in Group A (14.0%, 18.6%) than in Group B (1.8%, 3.7%) (P = 0.005). However, the 1, 5, and 10 yr patient survival rates were 93%, 93%, and 93%, in Group A and 92%, 90%, and 88% in Group B (P = 0.212). The survival outcome of pediatric LT is excellent and similar regardless of age. LTs in infancy are not riskier than those of children.
Adolescent ; Age Factors ; Child ; Child, Preschool ; End Stage Liver Disease/mortality/*surgery ; Female ; Graft Rejection/epidemiology ; Graft Survival ; Herpesviridae Infections/etiology ; Humans ; Infant ; Liver Transplantation/*adverse effects/*statistics & numerical data ; Lymphoproliferative Disorders/*etiology ; Male ; Proportional Hazards Models ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Vascular Diseases/etiology