Open AccessMultidrug-Resistant Bacteria and Disease Progression in Patients with End-Stage Liver Disease and after Liver Transplantation
Author(s) -
Kilian Friedrich,
Jessica Krempl,
Shigehiko Schamoni,
Theresa Hippchen,
Jan Pfeiffenberger,
Christian Rupp,
Daniel Gotthardt,
Philip Houben,
Rebecca von Haken,
Alexandra Heininger,
Thorsten Brenner,
Arianeb Mehrabi,
Karl-Heinz Weiss,
Markus Mieth
Publication year - 2019
Publication title -
journal of gastrointestinal and liver diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.641
H-Index - 48
eISSN - 1842-1121
pISSN - 1841-8724
DOI - 10.15403/jgld-212
Subject(s) - medicine , liver transplantation , gastroenterology , liver disease , decompensation , hepatorenal syndrome , hepatic encephalopathy , model for end stage liver disease , stage (stratigraphy) , transplantation , cirrhosis , paleontology , biology
Background: Multidrug-resistant (MDR) pathogens represent an emerging challenge in end-stage liver disease and in liver transplant recipients.
Methods: We evaluated the impact of MDR bacteria upon clinical outcomes in patients with end-stage liver disease (n = 777) at the time of enrollment on the liver transplant (LTx) waiting list, after first LTx (n = 645), and after second LTx (n = 128).
Results: Colonization/infection with MDR bacteria was present in 72/777 patients on the waiting list, in 98/645 patients at first LTx, and in 46/128 patients at second LTx. While on the LTx waiting list, the time until first hydropic decompensation (p = 0.021), hepatic encephalopathy (p < 0.001) and hepatorenal syndrome (p < 0.001) was reduced in the presence of MDR bacteria, which remained an independent risk factor of poor survival in multivariate analysis (p < 0.001). Following first and second liver transplant, MDR bacteria were associated with an increased risk of infection-related deaths (first LTx: p < 0.001; second LTx: p = 0.037) and reduced actuarial survival (first LTx: p < 0.001; second LTx: p = 0.046).
Conclusions: We showed that MDR pathogens are associated with poor outcomes before, after first and after recurrent LTx.