Bacterial Infections Post-Living-donor Liver Transplantation in Egyptian Hepatitis C Virus-Cirrhotic Patients: A Single-Center Study

AIM To determine risk factors, causative organisms and antimicrobial resistance of bacterial infections following living-donor liver transplantation（LDLT） in cirrhotic patients.METHODS This prospective study included 45 patients with hepatitis C virus-related end-stage liver disease who underwent LDLT at Ain Shams Center for Organ Transplant, Cairo, Egypt from January 2014 to November 2015. Patients were followed-up for the first 3 mo after LDLT for detection of bacterial infections. All patients were examined for the possible risk factors suggestive of acquiring infection pre-, intra-and post-operatively. Positive cultures based on clinical suspicion and patterns of antimicrobial resistance were identified. RESULTS Thirty-three patients（73.3%） suffered from bacterial infections; 21 of them had a single infection episode, and 12 had repeated infection episodes. Bile was the most common site for both single and repeated episodes of infection（28.6% and 27.8%, respectively）. The most common isolated organisms were gramnegative bacteria. Acinetobacter baumannii was the most common organism isolated from both single and repeated infection episodes（19% and 33.3%, respectively）, followed by Escherichia coli for repeated infections（11.1%）, and Pseudomonas aeruginosa for single infections（19%）. Levofloxacin showed high sensitivity against repeated infection episodes（P = 0.03）. Klebsiella, Acinetobacter and Pseudomonas were multi-drug resistant（MDR）. Pre-transplant hepatocellular carcinoma（HCC） and duration of drain insertion（in days） were independent risk factors for the occurrence of repeated infection episodes（P = 0.024）.CONCLUSION MDR gram-negative bacterial infections are common post-LDLT. Pre-transplant HCC and duration of drain insertion were independent risk factors for the occurrence of repeated infection episodes.