228. Early Recurrent Postoperative Bloodstream infections in Living-Donor Liver Transplant Recipients

Background Bloodstream infections (BSIs) represent a poor prognosis in living-donor liver transplant recipients (LDLT-Rs). Some patients develop recurrent BSIs. We evaluated the impacts of ER-BSIs on outcomes in LDLT-Rs. Methods All LDLT-Rs with follow-up data between January 2008 and December 2016 were included. Early BSIs (E-BSIs) defined as BSI events within 2 months after LDLT. ER-BSI was defined as new-onset BSI within 2 months due to another pathogen ≥48-hour interval, or relapse of BSI by the same pathogen ≥1-week interval with negative cultures in between. Logistic regression model was used to analyze risk factors for 1-year mortality. An associated factor of E-BSI and ER-BSI were also evaluated. Results Among 727 LDLT-Rs, 108 patients had 149 events with 170 isolated pathogens of E-BSI. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. Enterococcus (37.6%) was the most common pathogen. Intra-abdominal infection was the most common focus in the first episode of E-BSI and even significantly more common in ≥ second (59.3% vs. 82.9%, P = 0.007). Intra-abdominal and/or biliary complications were risk factors for both E-BSI and ER-BSI. Whereas high MELD score, longer cold ischemic time and longer recipient operative time were associated with E-BSI, longer post-transplant intensive care unit stay and longer donor operative time was associated with ER-BSI. 1-year survival rates of patients with or without single event of E-BSI were 81.3% and 92.4%, respectively. Patients having ER-BSI showed significantly low 1-year survival rates of 28.6% (Figure 1). ER-BSI was the most relevant risk factor for 1-year mortality (adjusted OR = 8.26; 95% CI = 4.30–15.88). Conclusion LDLT-Rs with ER-BSI showed very low survival rates accompanying with intra-abdominal and/or biliary complications. Clinicians should aware to prevent recurrence of BSI focusing on intra-abdominal complications in order to improve clinical outcomes of LDLT-R. Disclosures All authors: No reported disclosures.