Abstract
ObjectivesRising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail.MethodsPatients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list.ResultsIn total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died.ConclusionsColonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.
Highlights
Liver transplantation (LT) is an established treatment in patients with acute liver failure and advanced liver disease with and without hepatocellular carcinoma [1, 2]
Incidence of multidrug-resistant organisms (MDRO) colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list
One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT
Summary
Liver transplantation (LT) is an established treatment in patients with acute liver failure and advanced liver disease with and without hepatocellular carcinoma [1, 2]. Bacterial infections are a major cause of short-term mortality after LT, and unresolved infections are considered a contraindication against liver transplantation [3]. Infections are a major trigger of acute-on-chronic liver failure in patients both with compensated and decompensated cirrhosis [4,5,6]. Rising prevalence of multidrug-resistant organisms (MDRO) and especially colonization with multidrug-resistant gram-negative bacteria (MDRGN) is considered one of the most crucial and yet unresolved problems in public healthcare [7, 8]. Infections with MDRO in patients with cirrhosis have been associated with increased mortality [10, 11] and liver transplant recipients have a substantial risk for infections with MDRO [12, 13].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
