Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

• DOI: 10.1371/journal.pone.0245091
• Publication Date: 2021-01-22T20:16:30Z
• Authors: Philip G. Ferstl; Natalie Filmann; Eva-Maria Heilgen...; Andreas A. Schnit...; Wolf O. Bechstein; Volkhard A. J. Kempf; David Villinger; Tilman G. Schultze; Michael Hogardt; Christoph Stephan; Haitham Mutlak; Nina Weiler; Marcus M. Mücke; Jonel Trebicka; Stefan Zeuzem; Oliver Waidmann; Martin-Walter Welker
• Keywords: Adult; Liver Cirrhosis; Male; Methicillin-Resistant Staphylococcus aureus; 0301 basic medicine; Science; 610; Vancomycin-Resistant Enterococci; Tertiary Care Centers; 03 medical and health sciences; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria; Prevalence; Humans; ddc:610; Prospective Studies; Aged; Retrospective Studies; ddc:610; Q; R; Middle Aged; Staphylococcal Infections; Liver Transplantation; 3. Good health; Carbapenems; Medicine; Female; Gram-Negative Bacterial Infections; Research Article; Follow-Up Studies

Objectives Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail.

Methods Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list.

Results In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died.

Conclusions Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.