Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population

Figures & data

Table 1 Comparison of Patients with and without CRE Infection Within 30 Days After Liver Transplantation

	Patients with CRE Infection, n=26 (6.7%)	Patients without CRE Infection, n=361 (93.3%)	p
Age (years), median±SD)	48.6 2±11.29	50.65±10.21	0.330
Sex, male	22 (84.6%)	279 (77.3%)	0.472
BMI (kg/m^2)	28.12±9.25	26.59±9.32	0.419
MELD, median±SD)	25.23±11.22	19.74±9.86	0.007
Child-Pugh score	9.88±2.37	9.26±2.58	0.229
Pre-LT ICU stay	6 (23.1%)	38 (10.5%)	0.052
Underlying liver disease^a
HBV	18 (69.2%)	283 (78.4%)	0.278
HCC	7 (26.9%)	121 (33.5%)	0.490
Alcohol	4 (15.4%)	17 (4.7%)	0.020
AIH	1 (3.8%)	21 (5.8%)	0.675
PBC	0	1 (0.3%)	0.548
Others	2 (7.7%)	42 (11.6%)	0.541
Graft type			0.959
DBCD	4 (15.4%)	49 (13.6%)
DBD	6 (23.1%)	89 (24.6%)
DCD	16 (61.5%)	223 (61.8%)
Living donor	0	0
Cold ischemia time (min), median±SD)	590.26±162.39	550.26±180.99	0.305
Hot ischemia time (min), median±SD)	10.95±7.00	10.23±8.24	0.696
Intraoperative bleeding ≥1500 mL	14 (53.8%)	91 (25.2%)	0.002
CRE rectal carriage within 30 days post-LT	13 (50.0%)	52 (14.4%)	0.000
Vascular complications	3 (11.5%)	5 (1.4%)	0.000
Biliary complications	5 (19.2%)	24 (6.6%)	0.019
Reoperation	8 (30.8%)	19 (5.3%)	0.000
Ventilated >72 h	8 (30.8%)	25 (6.9%)	0.000
Renal replacement therapy >3 days	10 (38.5%)	36 (10.0%)	0.000

Note: ^aSome patient presented more than one cause of liver disease.

Abbreviations: AIH, autoimmune hepatitis; BMI, body mass index; CRE, carbapenem-resistant Enterobacteriaceae; DBD, donation after brain death; DBCD, donation after brain death followed by circulatory death; DCD, donation after circulatory death; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; MELD, Model for End-Stage Liver Disease; PBC, primary biliary cirrhosis; pre-LT ICU stay, pre-liver transplantation intensive care unit stay; SD, standard deviation.

Table 2 Multivariate Analysis of Risk Factors for CRE Infection After Liver Transplantation

	OR	95% CI	p
MELD	1.006	0.950–1.065	0.842
Alcoholic liver disease	4.094	0.910–18.415	0.066
Intraoperative bleeding ≥1500 mL	3.666	1.407–9.550	0.008
CRE rectal carriage within 30 days post-LT	5.516	2.113–14.399	0.000
Ventilated >72 h	2.344	0.636–8.639	0.201
Reoperation	2.673	0.773–9.244	0.121
Biliary complications	3.779	1.033–13.831	0.045
Vascular complications	5.357	0.690–41.600	0.109
Renal replacement therapy >3 days	3.762	1.196–11.833	0.023

Abbreviations: CI, confidence interval; CRE, carbapenem-resistant Enterobacteriaceae; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; OR, odds ratio.

Figure 1 Survival rates associated with carbapenem-resistant Enterobacteriaceae (CRE) infections. (A) A Kaplan–Meier analysis demonstrated reduced 180-day survival for liver transplant (LT) recipients with CRE infections versus LT recipients without CRE infections (51.5% vs 92.4%, log-rank p<0.001). (B) A Kaplan–Meier analysis demonstrated reduced 180-day survival for LT recipients with CRE bloodstream infections versus LT recipients with other pathogen bloodstream infections (41.0% vs 91.4%, log-rank p<0.001).