Impact of pre-transplant infection management on the outcome of living-donor liver transplantation in Egypt

Ahmed Mohamed Saleh,1 Essam Ali Hassan,1 Ahmed Ali Gomaa,1 Tamer Mahmoud El Baz,2 Mohamed El-Abgeegy,3 Mohamed Ismail Seleem,3 Yousry Esam-Eldin Abo-amer,4 Heba Fadl Elsergany,3 Eman Ibrahim El-Desoki Mahmoud,3 Sherief Abd-Elsalam51Tropical Medicine Department, Fayoum University, Al Fayyum, Egypt; 2Endemic Medicine Department, Cairo University, Giza, Egypt; 3Liver Transplantation Team, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 4Hepatology, Gastroenterology, and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, Gharbia, Egypt; 5Tropical Medicine Department, Tanta University, Tanta, EgyptBackground and aim: Liver transplantation (LT) has emerged as an established therapeutic option for patients with chronic liver disease. Patients with end-stage liver disease are at high risk of infection with multidrug-resistant organisms, which may affect the outcome of LT. The aim of this study was to evaluate the impact of pre-transplant infection on the outcome of living-donor LT.Methods: Prospective follow-up was done for 50 patients with chronic liver disease who had had LT performed from September 2013 to December 2017. We divided patients into group 1 (patients who had had infection within 3 months before transplantation with adequate treatment [n=20]), and group 2 (patients without infection [n=30]). Both groups were followed for 4 months post-operatively.Results: Patients with high Modelfor End-Stage Liver Disease scores were more susceptible to infection pre- and post-operatively, and chest infection was the most common infection pre-transplant. There were no significant statistical differences regarding hospital and ICU stay and post-operative course between the groups, but the mortality rate was higher in group 1 (40%) than in group 2 (23.3%), and the causes of mortality in the group 1 were mainly due to medical causes (infections and sepsis, 75%) versus 28.6% in group 2.Conclusion: Liver-cell failure and concomitant infection 3 months before LT with adequate treatment had no significant statistical differences regarding hospital, ICU stay, or medical complications, but post-operative infection and mortality rate were more frequent in group 1 and the causes of mortality were mainly medical.Keywords: hepatitis C virus, cirrhosis, steatosis, chronic liver disease, liver transplantation, outcome