High prevalence of Surgical Site Infections Increases graft loss and mortality in Liver Transplant Recipients: JAMA
According to a new cohort study, surgical site infections (SSIs) occurred in 6.0% of liver transplant (LT) recipients and were independently linked to graft loss and death. The study suggests that SSIs significantly reduce 1-year graft and recipient survival, highlighting the need for improved prevention strategies in this high-risk population. SSIs are one of the most prevalent health care–associated infections, and they can have serious consequences for LT patients. This study published in JAMA Network Open was conducted by Peter W. and colleagues in Switzerland.
A multicenter cohort study examining LT procedures in all Swiss transplant centers between May 2008 and September 2020, examined the incidence of SSIs, factors that increased the risk and the effect of SSIs on outcomes in postoperative LT patients. The data from this study showed that a prior liver transplantation and a living liver donation are independent factors that increase the risk of SSIs, and SSIs are associated with a higher risk of graft loss and mortality.
Data from the Swiss Transplant Cohort Study cohort study were analyzed with 1,158 LT adult recipients out of 1,333 total patients. The mean age of the cohort was 57.2 (IQR: 49.3-62.8) and 68.4% (792) of the cohort were male participants. SSIs were determined by use of seedier data from CDC, and follow-up data were collected one year after transplantation to assess outcomes (i.e., graft loss and mortality). Statistics performed on the data included multivariable regression models to assess independent risk factors and independent outcomes associated with SSI.
Main Results
The incidence of SSIs: Among 70 LT recipients (6.0%), an SSI was identified within 90 days of the transplant.
SSIs were either deep incisional (12.8%) or confirmed organ-space infections (77.1%).
Bacterial Pathogens: SSIs were bacterially confirmed in 80.0% (56 cases) of patients with the most common bacteria being Enterococcus spp (48.0%) and Escherichia coli (16.0%).
SSI risk factors were identified as follows:
(1) liver transplantation was an independent risk factor with a fourfold increase (OR, 4.01; 95% CI, 1.44-11.18; P = .008).
(2) Living liver donation was another independent risk factor with an increased risk of fourfold (OR, 4.08; 95% CI, 1.37- 12.16; P = .01).
Hospital stay and In-hospital outcomes:
SSIs were an independent risk factor for graft loss and/or death (HR, 3.24; 95% CI, 1.82-5.79; P < .001).
SSIs were linked to graft loss (HR, 2.97; 95% CI, 1.32-6.68; P = .02) and death (HR, 3.25; 95% CI, 1.44-7.35; P = .01).
This study identifies the serious impact of SSIs on liver transplantation outcomes. Prior liver transplant and living liver donation were independent risk factors for SSIs and were related to higher risk of graft loss and mortality rates. Infection prevention and management policies must be strengthened to offer improvements in long-term survival and transplant outcomes.
Reference:
Schreiber PW, Hoessly LD, Boggian K, et al. Surgical Site Infections, Risk Factors, and Outcomes After Liver Transplant. JAMA Netw Open. 2025;8(3):e251333. doi:10.1001/jamanetworkopen.2025.1333
