Preoperative infection within a month is associated with inferior post-transplant outcomes in adult living donor liver transplants

Background: Preoperative infection is a major determinant of outcome following liver transplant. The current study aims to assess the impact of the interval between preoperative infection and transplantation on post-operative outcomes following adult living donor liver transplantation (LDLT). Methods : Consecutive LDLT recipients (n=578), were divided into Group 1 (infection within 15 days), Group 2 (15 to 30 days), Group 3 (30 to 90 days), Group 4 (> 90 days), and Group 5 (without documented infection). The impact of timelines of pre-transplant infections on post-transplant outcomes were analyzed. Results: The group-1, 2, 3, 4 and 5 comprised 104(18%), 35(6%), 44(8%), 222(38%), and 173(30%) recipients respectively (n=578). Post-transplant sepsis and septic shock were seen in 278(48%) and 133(23%) patients respectively. Three-month mortality was 12.1% (70/578); 55.7% (39/70) of them had mortality attributed to sepsis. Patients with pre-LDLT infection within 30 days experienced higher three-month overall and sepsis-related mortality [25.17% vs 8%; OR:3.87(2.31-6.47); p=0.04] and [80% vs 31.42%; 8.73(2.92-26.04); p=<0.001] respectively, compared to recipients with infection beyond 30 days or no infection. With an upper limit of three-month mortality kept at 10%, ROC curve showed minimum pre-transplant ‘Infection-free interval’ of 27days (AUC=0.780). Multivariate analysis revealed pre-LDLT infection within 27 days [OR: 3.61(2.83-4.44)], pre-LDLT infection with MDR/XDR organisms [4.8 (1.6-14.9)], MELD >25 [2.51(1.09-5.79)], and biliary/vascular complications [1.82(1.10-2.74)] predicted three-month mortality. Conclusion: Infection within one month before LDLT is associated with high overall and sepsis-related three-month mortality. Preoperative infection within 27 days and MDR/XDR infections, MELD Na >25, and post-LDLT biliary/vascular complications predicted mortality.