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Objective To identify early Klebsiella pneumoniae (KP) infection after liver transplantation and its impact on prognosis. Methods Clinical data of 171 liver transplant recipients were retrospectively analyzed, and they were divided into the non-infection (n=52) and infection groups (n=119) according to the bacterial culture results at postoperative 2 weeks. In the infection group, KP was not detected in 86 cases (non-KP infection group), and KP was cultured in 33 cases (KP infection group). Preoperative, intraoperative and postoperative data were statistically compared between the non-infection and infection groups, and between the non-KP infection and KP infection groups. The risk factors of early KP infection after liver transplantation and the influencing factors of long-term survival of the recipients were analyzed.Results Compared with the non-infection group, model for end-stage liver disease (MELD) score and total bilirubin level were higher, the operation time was longer, the length of postoperative intensive care unit (ICU) stay and the length of hospital stay were longer, the amount of intraoperative red blood cell transfusion was higher, the hospitalization expense was higher, the incidence of severe complications was higher, white blood cell count, absolute neutrophil cell count and neutrophil-to-lymphocyte ratio at postoperative 14 and 30 d were higher, absolute lymphocyte count at postoperative 14 d was lower and hemoglobin level at postoperative 30 d was lower in the infection group. The differences were statistically significant (all P<0.05). Compared with the non-KP infection group, MELD score, total bilirubin level and aspartate aminotransferase (AST) level were higher, the operation time and the length of postoperative ICU stay were longer, the hospitalization expense was higher, the 90-d fatality was higher, the albumin level at postoperative 14 d was lower, and total bilirubin level at postoperative 30 d was higher in the KP infection group. The differences were statistically significant (all P<0.05). Among 33 recipients with KP infection, 16 cases were resistant to carbapenem antibiotics, and 7 of them died within postoperative 90 d. Seventeen cases were intermediate or sensitive to carbapenem antibiotics, and 4 of them died within postoperative 90 d. Preoperative MELD score ≥17 and operation time≥415 min were the independent risk factors for KP infection after liver transplantation (both P<0.05). The length of postoperative ICU stay ≥44 h and KP infection were the independent risk factors for long-term prognosis of liver transplantation (both P<0.05). Conclusions KP infection is an independent risk factor for death after liver transplantation. High preoperative MELD score and long operation time are the independent risk factors for early KP infection after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of different techniques of hepatic artery reconstruction on postoperative hepatic artery complications and clinical prognosis in liver transplantation. Methods Clinical data of 140 liver transplant recipients were retrospectively analyzed. All recipients were divided into the conventional hepatic artery reconstruction group (n=123) and special hepatic artery reconstruction group (n=17) according to hepatic artery reconstruction methods. Intraoperative and postoperative clinical indexes, the incidence of postoperative hepatic artery complications and survival rate were compared between two groups. Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at postoperative 1 d, total bilirubin (TB) at postoperative 7 d and prothrombin time international normalized ratio (PTINR) at postoperative 30 d in special hepatic artery reconstruction group were higher than those in conventional hepatic artery reconstruction group, and the differences were statistically significant (all P<0.05). There were no significant differences in the operation time, anhepatic phase, intraoperative blood loss, intraoperative transfusion volume of red blood cells, cold or warm ischemia time, the length of intensive care unit (ICU) stay, the length of hospital stay and postoperative blood flow of liver allograft between two groups (all P>0.05). In the conventional hepatic artery reconstruction group, 5 recipients developed hepatic artery complications, whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group, with no significant difference between two groups (P>0.05). In the special hepatic artery reconstruction group, the 1-, 3- and 5-year cumulative survival rates were equally 82.4%, compared with 85.0%, 78.9% and 75.6% in the conventional hepatic artery reconstruction group, respectively. There was no significant difference between two groups (all P>0.05). Conclusions When hepatic artery variations and (or) lesions are detected in donors and recipients, use of special hepatic artery reconstruction may effectively restore the hepatic arterial blood flow of liver allograft after liver transplantation, and will not affect the incidence of hepatic artery complications and survival rate of the recipients following liver transplantation. [ABSTRACT FROM AUTHOR]