Carbapenems versus Cephalosporin or Piperacillin-Tazobactam as Perioperative Antibiotic Prophylaxis in Liver Transplant Recipients with Model for End-Stage Liver Disease Scores of ≥30: A Retrospective Study in a Chinese Population

Figures & data

Table 1 Comparison of Patients Who Did and Did Not Receive Carbapenems as Antibiotic Prophylaxis

	Carbapenem Group (n = 27)	Non-Carbapenem Group (n = 78)	p
Age (years) (media [±SD])	48.8±12.1	48.2±11.4	0.818
Sex, male	22 (81.5%)	60 (76.9%)	0.622
BMI	25.4±6.8	26.9±8.3	0.415
Pre-LT ICU stay	12 (44.4%)	17 (21.8%)	0.023
Child–Pugh Score	12.0±1.2	11.6±1.3	0.162
MELD score (media [±SD])	35.2±3.9	33.4±3.5	0.030
Underlying liver disease*
HBV	21 (77.8%)	59 (75.6%)	0.822
HCC	0 (0%)	1 (1.2%)	1.000
Alcohol	5 (18.5%)	5 (6.4%)	0.120
AIH	0 (0%)	6 (7.7%)	0.335
PBC	0 (0%)	3 (3.8%)	0.567
Others	3 (11.1%)	12 (15.4%)	0.755
Graft type			0.382
DBD	9 (33.3%)	15 (19.2%)
DBCD	5 (18.5%)	12 (15.4%)
DCD	13 (48.1%)	50 (64.1%)
Living donor	0 (0.0%)	1 (1.3%)
Cold ischemia time (min), media (±SD)	547.5±137.7	523.4±164.4	0.528
Warm ischemia time (min), media (±SD)	9.0±11.0	10.4±9.2	0.545
Intraoperative bleeding of ≥1500 mL	15 (55.5%)	27 (34.6%)	0.056
Vasopressor support within 24 h after LT	8 (29.6%)	3 (3.8%)	0.001
Intra-abdominal hemorrhage	2 (7.4%)	4 (5.1%)	0.646
Vascular complications	0 (0%)	4 (5.1%)	0.570
Biliary complications	2 (7.4%)	7 (9.0%)	1.000
Reoperation	5 (18.5%)	11 (14.1%)	0.582
Ventilation for >72 h	15 (55.6%)	14 (17.9%)	0.000
Renal replacement therapy for >3 days	10 (37.0%)	16 (20.5%)	0.086
Infection within 30 days after LT	18 (66.7%)	30 (38.5%)	0.011
CRO infection	5 (18.5%)	9 (11.5%)	0.345

Note: *Some patients presented more than one cause of liver disease.

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

Table 2 Bacterial Pathogens of Infections

Pathogen	Episodes			p
	Total (n = 105)	Carbapenems (n = 27)	Non-Carbapenems (n = 78)
Enterobacteriaceae	19 (18.1%)	5 (18.5%)	14 (18.0%)	0.947
Pseudomonas aeruginosa	2 (1.9%)	1 (3.7%)	1 (1.3%)	0.428
Acinetobacter baumannii	10 (9.5%)	3 (11.1%)	7 (9.0%)	0.744
Stenotrophomonas maltophilia	8 (7.6%)	5 (18.5%)	3 (3.9%)	0.013
Burkholderia spp.	7 (6.7%)	2 (7.4%)	5 (6.4%)	0.858
Enterococcus spp.	18 (17.1%)	7 (25.9%)	11 (14.1%)	0.160
Others	12 (11.4%)	1 (3.7%)	10 (12.8%)	0.182

Table 3 Univariate and Multivariate Analyses of Risk Factors for Infections After Liver Transplantation

Risk Factor	Univariate Analysis			Multivariate Analysis
	OR	95% CI	p	OR	95% CI	p
Prophylaxis with carbapenems	3.200	1.274–8.038	0.013	1.940	0.638–5.898	0.243
MELD score	1.093	0.982–1.216	0.103	NS	NS	NS
Intraoperative bleeding of ≥1500 mL	1.333	0.609–2.921	0.472	NS	NS	NS
Vasopressor support within 24 h after LT	14.737	1.811–119.923	0.012	6.352	0.631–63.918	0.117
Ventilation for >72 h	3.810	1.527–9.406	0.004	0.972	0.297–3.184	0.963
Reoperation	4.417	1.319–14.784	0.016	3.942	1.004–15.468	0.049
Biliary complications	0.945	0.239–3.738	0.936	NS	NS	NS
Vascular complications	3.733	0.375–37.123	0.261	NS	NS	NS
Renal replacement therapy for >3 days	2.925	1.159–7.380	0.023	1.871	0.618–5.666	0.268
Pre-transplant ICU stay	2.056	0.862–4.904	0.104	NS	NS	NS
Child–Pugh score	1.739	1.248–2.422	0.001	1.726	1.183–2.519	0.005
Intra-abdominal bleeding	2.500	0.437–14.287	0.303	NS	NS	NS

Abbreviations: CI, confidence interval; ICU, intensive care unit; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; NS, not significant; OR, odds ratio.

Table 4 Factors Associated with 180 Days of Survival in Patients After Liver Transplantation in the Cox Model

Risk Factor	Univariate Analysis			Multivariate Analysis
	HR	95% CI	p	HR	95% CI	p
Prophylaxis with carbapenems	1.741	0.685–4.424	0.244	NS	NS	NS
MELD score	1.163	1.034–1.309	0.012	1.216	1.040–1.422	0.014
Intraoperative bleeding of ≥1500 mL	0.884	0.348–2.246	0.796	NS	NS	NS
Vasopressor support within 24 h after LT	1.699	0.495–5.832	0.4	NS	NS	NS
Ventilation for >72 h	2.135	0.859–5.311	0.103	NS	NS	NS
Biliary complications	0.547	0.073–4.097	0.557	NS	NS	NS
Vascular complications	4.521	1.040–19.655	0.044	9.302	1.769–48.914	0.008
Renal replacement therapy for >3 days	3.926	1.592–9.677	0.003	2.119	0.792–5.672	0.135
Pre-transplant ICU stay	1.654	0.651–4.203	0.29	NS	NS	NS
Child–Pugh score	1.363	0.951–1.955	0.092	NS	NS	NS
Intra-abdominal bleeding	3.936	1.144–13.542	0.03	9.056	2.185–37.541	0.002
Infection within 30 days after LT	2.249	0.885–5.715	0.089	NS	NS	NS
CRO infection	3.671	1.390–9.696	0.009	6.669	2.248–19.788	0.001

Abbreviations: CRO, carbapenem-resistant organism; CI, confidence interval; HR, hazard ratio; ICU, intensive care unit; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; NS, not significant.

Figure 1 The 180-day post-transplant survival rate in patients who received carbapenems and those who received non-carbapenems for surgical prophylaxis (74.1% and 84.6%, log-rank p = 0.238).