The impact of intraoperative diagnosis of spontaneous bacterial peritonitis or bacterascites in liver transplantation

BACKGROUND: Bacterial infections can negatively impact post-liver transplant morbidity and mortality, and the impact of incipient spontaneous bacterial peritonitis or bacterascites from intraoperative ascitic fluid is unknown. The present study's objectives were to analyse the risk factors for post-liver transplant infection and survival within 30-days after transplant. METHODS: This is a single-center retrospective cohort study of liver transplant patients from 2010‒2017, whose ascitic fluid collected during transplant was sent for analysis. Survival analysis using the Kaplan-Meier method and Cox regression in the multivariate analysis was used to determine risk factors for post-transplant infection and survival. RESULTS: Of 297 patients, 22 had intraoperative SBP, 40 had bacterascites, and 235 had a normal ascitic fluid. 67% were male, median age 53-years, and median MELD score of 24. In multivariate analysis, there was no association between the presence of SBP or the presence of bacterascites and the occurrence of infection or death, and although it was not clinically significant, there was a trend towards worse survival in the bacterascites group. Patients undergoing post-transplant reoperation (OR = 2.28, 95% CI 1.12-4.60, p = 0.022), post-transplant MDR colonization (OR = 4.39, 95% CI 2.61-7.39, p < 0.001), and post-transplant dialysis (OR = 2.20, 95% CI 1.31-3.69, p = 0.003) had a higher rate of infection in the first 30-days after transplantation; pre-transplant MDR colonization, early graft dysfunction and low body mass index were independent predictors of worse survival. CONCLUSIONS: Intraoperative SBP and bacterascites that received targeted treatment did not impact infections nor survival rates up to 30-days after liver transplant, while most episodes were treated. In this population of severe patients with ascites, patients undergoing reoperation, post-transplant MDR colonization and post-transplant dialysis were at higher risk of infection.