Risk Factors and Outcomes of Carbapenem-Resistant Enterobacteriaceae Infection After Liver Transplantation: A Retrospective Study in a Chinese Population

Background: There is an increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infection after liver transplantation (LT). Improved understanding of the risk factors and outcomes of CRE infections can help us to develop effective preventive strategies and even guide early treatment of high-risk LT patients. Methods: This was a retrospective study involving all Chinese adult patients who underwent LT between December 2017 and September 2019 in our center. We analyzed the possible risk factors and outcomes associated with CRE infections in the first 30 days post-LT. Results: A total of 387 patients underwent LT. Among them, 26 patients (6.7%) developed CRE infections within 30 days after transplantation. Patients with CRE infections had significantly lower 30-day and 180-day survival rates (80.8% vs 96.4%, p<0.001; 51.5% vs 92.4%, p<0.001). Multivariate analysis identified that intraoperative blood loss equal to or more than 1500 mL (odds ratio [OR], 3.666; 95% confidence interval [CI], 1.407-9.550; p=0.008), CRE rectal carriage within 30 days post-LT (OR, 5.516; 95% CI, 2.113-14.399; p=0.000), biliary complications (OR, 3.779; 95% CI, 1.033-13.831; p=0.045) and renal replacement therapy for more than 3 days (OR, 3.762; 95% CI, 1.196-11.833; p=0.023) were independent risk factors for CRE infections within 30 days post-LT. Conclusion: CRE infections within 30 days post-LT were associated with worse outcomes. Intraoperative blood loss equal to or more than 1500 mL, CRE rectal carriage within 30 days postLT, biliary complications and renal replacement therapy for more than 3 days were independent risk factors of CRE infections after LT.