Differences between infectious disease events in first liver transplant versus re-transplantation in the Swiss Transplant Cohort Study.

Kusejko, Katharina; Neofytos, Dionysios; Hirsch, Hans H; Meylan, Pascal; Boggian, Katia; Hirzel, Cédric; Garzoni, Christian; Kouyos, Roger D; Mueller, Nicolas J; Schreiber, Peter W (2021). Differences between infectious disease events in first liver transplant versus re-transplantation in the Swiss Transplant Cohort Study. Liver transplantation, 27(9), pp. 1283-1290. Wiley 10.1002/lt.26068

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BACKGROUND & AIMS

Re-transplantation after graft failure is increasingly performed, but inferior graft survival, patient survival and quality of life has been reported. The role of infectious disease (ID) events in this less favorable outcome is unknown.

APPROACH & RESULTS

We analyzed ID events after first liver transplantation (FLTpx) and re-transplantation (re-LTpx) in the Swiss Transplant Cohort Study. Clinical factors were compared after FLTpx and re-LTpx, survival analysis was applied to compare the time to ID events after FLTpx and after re-LTpx, adjusted for age, gender, MELD score, donor type, liver transplant type (whole vs. split liver) and duration of transplant surgery. In total, 60 patients were included (65% male, median age of 56 years). Overall, 343 ID events were observed, 204 (59.5%) after the FLTpx and 139 (40.5%) after re-LTpx. Bacterial infections were most frequent (193/343, 56.3%), followed by viral (43/343, 12.5%) and fungal (28/343, 8.2%) infections, with less infections by Candida spp. but more by Aspergillus spp. after re-LTpx (P-value = 0.01). The most frequent infection site was bloodstream infection (86, 21.3%), followed by liver and biliary tract (83, 20.5%) and intraabdominal (63, 15.6%) infections, After re-LTpx, more respiratory tract and surgical site infections were observed (P-value < 0.001). The time to first infection was shorter after FLTpx (adjusted hazard ratio (HR) = 0.5 [confidence interval: 0.3, 1.0], p = 0.04). Reduced hazards for ID events after re-LTpx were also observed when modelling recurrent events (adjusted HR = 0.5 [0.3, 0.8], P-value = 0.003).

CONCLUSIONS

The number of infections was comparable after FLTpx and re-LTpx, however, differences regarding infection sites and fungal species were observed. Hazards were reduced for infection after re-LTpx.

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