Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 18, 2017; 9(20): 896-904
Published online Jul 18, 2017. doi: 10.4254/wjh.v9.i20.896
Bacterial infections post-living-donor liver transplantation in Egyptian hepatitis C virus-cirrhotic patients: A single-center study
Mohamed F Montasser, Nadia A Abdelkader, Sara M Abdelhakam, Hany Dabbous, Iman F Montasser, Yasmine M Massoud, Waleed Abdelmoaty, Shereen A Saleh, Mohamed Bahaa, Hany Said, Mahmoud El-Meteini
Mohamed F Montasser, Nadia A Abdelkader, Sara M Abdelhakam, Hany Dabbous, Iman F Montasser, Yasmine M Massoud, Waleed Abdelmoaty, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Shereen A Saleh, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Mohamed Bahaa, Hany Said, Mahmoud El-Meteini, Department of Hepatobiliary Surgery, Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Author contributions: Montasser MF and El-Meteini M contributed equally to the work; Montasser MF, El-Meteini M, Abdelkader NA, Abdelhakam SM, Dabbous H and Montasser IF designed the research; Montasser MF, El-Meteini M, Dabbous H, Montasser IF, Massoud YM, Abdelmoaty W, Saleh SA, Bahaa M and Said H performed the research; Montasser MF, El-Meteini M, Abdelkader NA, Abdelhakam SM, Massoud YM, Saleh SA, Bahaa M and Said H contributed analytical tools; Montasser MF, El-Meteini M, Abdelkader NA, Abdelhakam SM, Dabbous H, Montasser IF, Massoud YM and Abdelmoaty W analyzed the data; Abdelhakam SM, Dabbous H, Montasser IF, Massoud YM, Abdelmoaty W and Saleh SA wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Research Ethics Committee of Faculty of Medicine, Ain Shams University Institutional Review Board.
Clinical trial registration statement: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02777632, and the registration identification number is: NCT02777632.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest or financial disclosures.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at saratropical@yahoo.com. The participants gave informed consent for the data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara M Abdelhakam, MD, Assistant Professor, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Khalifa El-Maamon St., Abbassia, Cairo 11341, Egypt. sara_abdelhakam@med.asu.edu.eg
Telephone: +20-22-1601548 Fax: +20-22-2598751
Received: February 8, 2017
Peer-review started: February 14, 2017
First decision: April 17, 2017
Revised: May 8, 2017
Accepted: June 12, 2017
Article in press: June 13, 2017
Published online: July 18, 2017
Processing time: 159 Days and 4.4 Hours
Abstract
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 gram-negative 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.

Keywords: Living-donor liver transplantation; Bacterial infection; Multi-drug resistance; Hepatitis C virus; Liver cirrhosis

Core tip: We evaluated 45 patients with hepatitis C virus-related end-stage liver disease for the occurrence of bacterial infections during the first 3 mo post-living-donor liver transplantation. 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). Multi-drug resistant gram-negative bacteria, especially Klebsiella, Acinetobacter and Pseudomonas, were the most commonly isolated bacteria. Pre-transplant hepatocellular carcinoma and duration of drain insertion were independent risk factors for occurrence of repeated infection episodes.