Analysis of the post-operative pulmonary infection in adult-to-adult living donor liver transplant recipients

Abstract

To study the incidence, etiology, outcome, and risk factors of early (is less than or equal to 30 days) pulmonary infection following adult-to-adult living donor liver transplantation (AALDLT). Medical records of 108 AALDLT without pre-operative respiratory disease from 2005 to 2008 were retrospective to evaluate the incidence, etiology, outcome, and risk factors of pulmonary infection following AALDLT. Univariate analysis was used to determine relative risk factors leading to postoperative pneumonia, and significant factors (P less than 0.05) were then used for multivariate logistic regression analysis. The incidence of pneumonia was 22.2 % (n = 24 ); etiology including bacteria (n = 23, 21.3%), gram negative bacteria account for 78.3%, fungi (n = 4, 3.7%) and virus (n = 1, 0.9%), 4 patients were coinfection by bacteria and fungi; 6 among 24 patients (25%) and 4 out of the other 84 patients (4.76%) died early following the AALDLT, respectively (x2 = 6.850, P = 0.009). In univariate analysis, intraoperative volume of whole blood/packed red blood cells transfusion (P less than 0.01), intraoperative volume of fresh frozen plasma transfusion (P = 0.001), total volume of intraoperative transfusion (P = 0.015), mechanical ventilation (P less than 0.01), intensive unit care (ICU) stay (P = 0.012) and acute rejection (P = 0.001) are of statistical significance. Multivariate logistic regression showed only mechanical ventilation (P = 0.023) and acute rejection (P = 0.026) are independent factors predicting pneumonia. Gram negative bacteria is the main etiology for pneumonia following AALDLT which has high morbidity and mortality; mechanical ventilation and acute rejection are independent risk factors.