Changes in Surgical Site Infections after Living Donor Liver Transplantation

Authors: Masaki Yamamoto, Shunji Takakura , Yoshitsugu Iinuma, Go Hotta, Yasufumi Matsumura, Aki Matsushima, Miki Nagao, Kohei Ogawa, Yasuhiro Fujimoto, Akira Mori, Yasuhiro Ogura, Toshimi Kaido, Shinji Uemoto, Satoshi Ichiyama

Abstract

Surgical site infections (SSIs) are a major threat for liver transplant recipients. We prospectively studied SSIs after living donor liver transplantation (LDLT) at Kyoto University Hospital from April 2001 to March 2002 (1st period) and from January 2011 to June 2012 (2nd period). We investigated the epidemiology of SSIs after LDLT and determined the differences between the two periods. A total of 129 adult recipients (66 during the 1st period and 63 during the 2nd period) and 72 pediatric recipients (39 and 33) were included in this study. The SSI rates for each period were 30.3% (1st period) and 41.3% (2nd period) among the adult recipients and 25.6% and 30.3% among the pediatric recipients. The overall rates of 30-day mortality among adult transplant recipients with SSIs were 10.0% (1st period) and 3.9% (2nd period). No pediatric recipient died from SSIs after LDLT in either period. The incidence of Enterococcus faecium increased from 5.0% to 26.9% in the adults and from 10.0% to 40.0% in the pediatric patients. Extended-spectrum β-lactamase-producing Enterobacteriaceae were emerging important isolates during the 2nd period. For this period, a univariate analysis showed that ABO incompatibility (P = 0.02), total operation duration (P = 0.01), graft-to-recipient body weight ratio (GRWR [P = 0.04]), and Roux-en-Y biliary reconstruction (P<0.01) in the adults and age (P = 0.01) and NHSN risk index (P = 0.02) in the children were associated with SSI development. In a multivariate analysis, lower GRWR (P = 0.02) and Roux-en-Y biliary reconstruction (P<0.01) in the adults and older age (P = 0.01) in the children were independent risk factors for SSIs during the 2nd period. In conclusion, SSIs caused by antibiotic resistant bacteria may become a major concern. Lower GRWR and Roux-en-Y biliary reconstruction among adult LDLT recipients and older age among pediatric LDLT recipients increased the risk of developing SSIs after LDLT.

Citation: Yamamoto M, Takakura S, Iinuma Y, Hotta G, Matsumura Y, Matsushima A, et al. (2015) Changes in Surgical Site Infections after Living Donor Liver Transplantation. PLoS ONE 10(8): e0136559. doi:10.1371/journal.pone.0136559

Editor: Mercedes Susan Mandell, University of Colorado, UNITED STATES

Received: March 25, 2015; Accepted: August 4, 2015; Published: August 31, 2015

Copyright: © 2015 Yamamoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Data Availability: All relevant data are all contained within the paper.

Funding: This work was supported by a grant from the Ministry of Health, Labor and Welfare of Japan (H21-Shinko-Ippan-009 and H23-Shinko-Ippan-018). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: No commercial relationships or potential conflicts of interest exist. The authors have declared that no competing interests exist.

Acknowledgments

This work was supported by a grant from the Ministry of Health, Labor and Welfare of Japan (H21-Shinko-Ippan-009 and H23-Shinko-Ippan-018). The authors have declared that no competing interests exist.

Author Contributions

Conceived and designed the experiments: MY ST. Performed the experiments: MY ST. Analyzed the data: MY ST. Contributed reagents/materials/analysis tools: MY ST. Wrote the paper: MY ST YI GH YM AMa MN KO YF AMo YO TK SU SI.

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