Wenjing Wang, Ding Wang, Yi Zhang, Jialu Li, Ting Lin, Bo Wang, Xiaogang Zhang, Bo Guo
Experimental and Clinical Transplantation - 2025;23(9):595-603
Objectives: In this study, we analyzed the clinical characteristics of infections and death risk predictors in older recipients (>=65 years old) after liver transplant. Materials and Methods: We conducted a retrospective analysis of 34 older recipients after liver transplant and analyzed the composition and distribution of pathogens, drug resistance, and death risk predictors of infection. Results: Among 34 patients, 17 (50%) developed postoperative infections; bacterial and fungal infections mainly occurred within 30 days after surgery. Respiratory and biliary tract were common infection sites. Gram-negative bacteria were more common than gram-positive bacteria (63.5% vs 36.5%, respectively), and Klebsiella pneumoniae and Enterococcus faecium ranked as the top 2 pathogens. Klebsiella pneumoniae exhibited high levels of drug resistance, with varying carbapenemase profiles, and maintained relatively good susceptibility (>50%) only to tigecycline, ceftazidime-avibactam, and polymyxin; all E faecium isolates were sensitive to vancomycin. Infection-related deaths occurred in 4 cases, accounting for 80% of total mortality. Postoperative septic shock was identified as a risk factor for all-cause 1-year mortality after liver transplant in older patients. Conclusions: Postoperative infection in older liver transplant recipients was characterized by high incidence, high drug resistance, and high infection-related mortality. The main type of gram-negative bacteria was K pneumoniae, which was highly drug-resistant and difficult to treat. Postoperative septic shock was a death risk predictor. Early identification and optimized treatment of postoperative infections and secondary septic shock are crucial for reduction of all-cause 1-year mortality.
