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Orthotopic liver transplantation (OLT) is accompanied by a significant postoperative infection risk. Immunosuppression to prevent rejection increases the susceptibility to infections, mainly by impairing the adaptive immune system. Genetic polymorphisms in the lectin complement pathway of the donor have recently been identified as important risk determinants of clinically significant bacterial infection (CSI) after OLT. Another genetic factor involved in innate immunity is  NOD2 , which was reported to be associated with increased risk of spontaneous bacterial peritonitis in cirrhotic patients.    Methods  We assessed association of three genetic  NOD2  variants (R702W, G908R and 3020insC) with increased risk of CSI after OLT. 288 OLT recipient-donor pairs from two tertiary referral centers were genotyped for the three  NOD2  variants. The probability of CSI in relation to  NOD2  gene variants was determined with cumulative incidence curves and log-rank analysis.    Results  The R702W  NOD2  variant in the recipient was associated with CSI after OLT. Eight out of 15 (53.3%) individuals with a mutated genotype compared to 80/273 (29.3%) with wild type genotype developed CSI (p=0.027, univariate cox regression), illustrated by a higher frequency of CSI after OLT over time (p=0.0003, log rank analysis). Multivariate analysis (including the donor lectin complement pathway profile) showed independence of this R702W  NOD2  association from other risk factors (HR 2.0; p=0.04). The other  NOD2  variants, G908R and 3020insC, in the recipient were not associated with CSI. There was no association with CSI after OLT for any of the  NOD2  variants in the donor.    Conclusion  The mutated  NOD2  R702W genotype in the recipient is independently associated with an increased risk of bacterial infections after liver transplantation, indicating a predisposing role for this genetic factor impairing the recipient’s innate immune system.

Recipient’s Genetic R702W NOD2 Variant Is Associated with an Increased Risk of Bacterial Infections after Orthotopic Liver Transplantation