Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2016; 6(2): 389-395
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.389
Ventilator associated pneumonia following liver transplantation: Etiology, risk factors and outcome
Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Nava, Pierluigi Viale, Stefano Faenza
Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy
Stefano Nava, Department of Specialist, Diagnostic and Experimental Medicine, Pneumology and Respiratory Intensive Care Unit, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy
Pierluigi Viale, Clinic of Infectious Diseases, Department of Internal Medicine Geriatrics and Nephrologic Diseases, University of Bologna, 40138 Bologna, Italy
Author contributions: Siniscalchi A and Faenza S performed the research; Aurini L and Beatrice B wrote the paper; Gamberini L analyzed and collected the data; Nava S and Viale P revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Sant’Orsola Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Siniscalchi, MD, Division of Anesthesiology, Department of General Surgery of Sant’Orsola Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. sinianest@libero.it
Telephone: +39-051-6363101 Fax: +39-051-6363105
Received: January 16, 2016
Peer-review started: January 18, 2016
First decision: February 29, 2016
Revised: April 4, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: June 24, 2016
Processing time: 158 Days and 0.2 Hours
Abstract

AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients undergoing orthotopic liver transplantation (OLT).

METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria.

RESULTS: VAP occurred in 18 (7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation (MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae (79%). Univariate logistic analysis showed that model for end-stage liver disease (MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariate analysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP.

CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.

Keywords: Liver transplantation; Ventilator associated pneumonia; Perioperative period; Infection

Core tip: Ventilator associated pneumonia (VAP) is a serious perioperative complication in liver transplant recipients, and its etiology and risk factors are still poorly understood. Therefore, we conducted this retrospective study in a big sample of patients to evaluate the incidence, risk factors, etiological agents and outcome of VAP considering 242 consecutive liver transplant recipients. VAP occurred with an incidence of 10 per 1000 d of mechanical ventilation (MV). Multivariate analysis demonstrated that VAP was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP.