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岭南现代临床外科 ›› 2020, Vol. 20 ›› Issue (01): 108-112.DOI: 10.3969/j.issn.1009-976X.2020.01.024

• 综述 • 上一篇    下一篇

肝移植术后感染的流行病学特征及危险因素

  

  1. 1.广东医科大学研究生学院,广东湛江 524000;2. 中山市人民医院肝胆外科,广东中山 528400
  • 通讯作者: 陈伟强

Epidemiological characteristics and risk factors of infection after liver transplantation

  1. 1. Guangdong Medical University Postgraduate College, Zhanjiang, Guangdong 524000, China; 2. Department of Hepatobiliary Surgery, Zhongshan People?? s Hospital, Zhongshan, Guangdong 528400, China
  • Online:2020-02-20 Published:2020-02-20
  • Contact: CHEN Wei-qiang

摘要:

肝移植术后感染的流行病学特征及危险因素

钟思权1, 陈伟强2*

[摘要] 目前肝移植(LT)已成为终末期肝病和晚期肝癌患者的指南推荐治疗方法,其术后5年存活率接近60%~80%,但其术后感染却仍是影响肝移植患者生存率的主要原因,本文将对肝移植术后感染的病原学特点及危险因素进行综述,有望增加对术后感染的认识。

[关键词] 肝移植;细菌感染;真菌感染;病毒感染;危险因素

肝移植已成为终末期肝病和肝癌患者的指南推荐治疗方法。由于外科技术、免疫抑制疗法和术后护理的关键进展,肝移植后的存活率有了显著提高,其术后5年存活率接近60%~80%[1,2]。但大多数受者易患机会性感染,约80%的肝移植受者术后1年至少有过1次感染。现有研究表明,感染是肝移植术后1年内最主要的并发症和死亡原因[3]。其中细菌感染最为常见,其次为真菌和病毒感染。本文将对肝移植术后感染的病原学特征及危险因素进行综述。

1 感染流行病学特征

1.1 细菌感染

由于肝移植手术的复杂性,肝移植受者较其他器官移植更易发生细菌感染,肝移植术后细菌感染通常在术后2个月内发生,其感染的优势菌群与不同地域特点及环境有关,但革兰阴性菌和革兰阳性菌仍是主要的感染病原体[4]

1.1.1 革兰阴性菌(GNB) 肠杆菌属是肝移植受者的主要致病菌,其感染大多与移植技术、术后胆漏及胆道梗阻有关。其中肝动脉的血栓形成会导致移植肝缺血,从而导致肝脓肿形成。GNB感染部位大都集中在腹腔深部感染、菌血症、肺炎、尿路感染及导管相关感染[5]。常见的致病菌有大肠杆菌、克雷伯杆菌、马氏沙雷菌等[6,7]。而近年来,随着肝移植发展,多重耐药的肠杆菌菌株(MDR-GNB)呈增多趋势,成为肝移植术后感染的重要菌种[8]。在中国的一项研究中,56%的GNB感染是由肝移植后的多重耐药菌引起的[9]。据最大的移植中心之一报道,9个LT受者中有6个(67%)存在抗碳青霉烯类GNB定植[10],而耐药菌的产生主要由于过度使用广谱抗生素及长时间气管插管引起[9]。同时还包括移植术后肾衰竭、长时间院内治疗、手术并发症和各种侵入性操作的使用[9]。MDR-GNB的产生容易导致肝移植手术的失败及较高的死亡率[11],因此早期的诊断、适当的治疗、院内环境感染的控制和合理抗生素的使用对提高生存率至关重要。

1.1.2 革兰阳性菌(GPB) 革兰阳性菌感染常见的病原菌为葡萄球菌、链球菌和肠球菌。尽管GNB感染在一些中心呈上升趋势[7],但耐甲氧西林金黄色葡萄球菌(MRSA)和耐万古霉素肠球菌(VRE)仍对移植后的受体存在着较大的威胁[12]。Gearhart等研究[13]表明,VRE感染组患者的生存率低于非VRE感染组(52%vs 82%,P=0.048),其多与既往使用抗生素、多次腹部手术和胆道并发症及血管内血栓形成有关。利奈唑胺多用于VRE感染的治疗,而Dobbs等[14]报道了耐利奈唑胺VRE的院内感染传播。而对利奈唑胺耐药、万古霉素耐药的肠杆菌的出现,不仅在肝移植患者中,而且在公共卫生领域也引起了极大的关注,因此谨慎使用利奈唑胺至关重要[14]

随着移植患者的增多,MRSA的发生率在不断增加,尤其在移植后的血流感染中占很大的比例。据西班牙的一项多中心研究报告说,MRSA感染引起的菌血症是移植后患者死亡的独立危险因素[15]。然而据Malinis等[16]报道,实体器官移植受者的金黄色葡萄球菌菌血症发生率和死亡率明显低于非移植受者;这种差异可能是由于早期抗生素治疗、传染病医生的参与以及免疫调节治疗的效果。但MRSA感染仍是我们不容忽视的威胁。

1.2 真菌感染

肝移植术后免疫抑制剂的使用使其更易发生真菌感染,发生率为7%~42%[17]。真菌感染部位主要在肺部、尿道,其次是腹腔。其中念珠菌是真菌感染的主要致病菌,其占真菌感染的68%,其次是曲霉菌11%、隐球菌6%[18]。念珠菌感染最常见于移植后的前3个月,但也常见于移植后晚期[18-21]。而侵袭性曲霉菌感染多发生在术后1月内,但也可能在移植后晚期出现[22,23]

1.2.1 念珠菌 侵袭性念珠菌感染最常见的表现为念珠菌血症、腹膜炎和念珠菌尿[18,19]。在肝移植受者中,移植术中肠液外溢引起胃肠道菌群移位被认为是念珠菌的一种常见感染机制[24]。而手术时间的延长、肾功能不全、重症肝衰竭、移植物功能障碍、再移植、大量输血是导致侵袭性念珠菌感染的危险因素[25]。念珠菌的诊断主要是通过移植受者血液中检出真菌,然而在胃肠道菌群移位的情况下,念珠菌通常很快从血液中清除,使得其血培养敏感性只有60%~80%[24,26]。因此对于使用广谱抗菌素却仍然持续性白细胞增多或发热患者应高度怀疑念珠菌感染。

1.2.2 曲霉菌 曲霉菌的感染仅次于念珠菌,大约占到侵袭性真菌感染的1/4[27]。烟曲霉是移植后的最常见霉菌,其次是毛霉菌。而术前类固醇激素的应用及单克隆抗体的应用容易造成移植术后曲霉菌的感染[28]。曲霉菌感染在移植人群中通常表现为下呼吸道病变,表现为肺血管紧张性收缩、刺激性咳嗽,随后出现呼吸急促等肺栓塞症状,但也可以累及鼻窦或中枢神经系统[23,29,30]。但由于诊断较晚,霉菌感染尤其致命[23]。肺曲霉病最常见的影像学表现为肺上单发直径>1 cm的结节,结节周围带有晕状征,即围绕结节的磨砂玻璃样改变。其他不典型影像学表现还包括肺部肿块或斑片状实变影[29,31]

1.2.3 隐球菌 隐球菌感染可在移植后数月出现,是实体器官移植中侵袭性真菌感染的第三大常见病因[20.32.33]。隐球菌病的已知危险因素包括糖皮质激素、免疫抑制剂及大量抗菌药物的使用[34,35]。隐球菌病往往在移植后以亚急性或慢性感染的形式出现,在肝移植术后出现时间平均为8.8个月,其中绝大多数病例发生在肝移植后1年内[36]。在早期的综述中,肝移植后隐球菌病的发生率为2.4%,死亡率为40%[36]。随着对隐球菌病认识的加深,钙调神经磷酸酶抑制剂和氟康唑预防的广泛使用,隐球菌病的发生率和临床表现也在不断发生变化[37]。中枢神经系统受累是移植术后隐球菌感染常见的死亡原因[33],由于其隐球菌脑膜炎起病缓慢,初期症状不典型,容易误诊。而虽然中枢神经系统受累是常见的,但在钙调神经磷酸酶抑制剂广泛使用的时代,更多的患者大多表现为孤立的肺隐球菌病[36],在影像学表现多为结节性或空洞性浸润病灶[36]

1.3 病毒感染

病毒感染对肝移植受者的威胁是不可忽视的。虽然移植后早期以院内感染为特征,但由于患者术后免疫抑制状态,巨细胞病毒(CMV)、EB病毒、单纯疱疹病毒(HSV)导致的机会性病毒感染大多发生在移植术后的前6个月。

1.3.1 巨细胞病毒感染 巨细胞病毒(CMV)是肝移植术后最常见的病毒病原体。CMV能通过引起受者发热、骨髓抑制(最常见的是白细胞和中性粒细胞减少)、移植物功能障碍、移植物排斥反应和肝动脉血栓形成等影响受者的预后[38]。而在接受肝移植的患者中,CMV的发生与细菌、真菌感染或病毒病原体的再活化的有关[39]。现有研究表明,DNA检测是诊断和监测CMV感染最常用的实验室参数[40]。而在手术前后使用抗病毒药物预防CMV感染的发生在肝移植中是合理的,静脉更昔洛韦和口服缬更昔洛韦是治疗巨细胞病毒病最常用的药物,且治疗时间应个体化,一般为3~6个月[41]。单纯疱疹病毒-1(HSV-1)是另一种机会性病毒,可随着感染病程发展而表现出明显的症状[42]

此外,慢性病毒感染,如乙型肝炎(HBV)和丙型肝炎(HCV)或EB病毒(EBV)的再活化可能导致继发性恶性肿瘤或直接对同种异体移植物的细胞毒性损伤。如EB病毒可引起致命的移植后淋巴增生紊乱[43],乙肝病毒或丙肝病毒再感染则可导致病毒性肝炎和肝癌的复发。人类微小病毒B19导致慢性单纯性红细胞生成障碍而出现严重贫血[44]

目前预防肝移植术后病毒感染的策略包括接种疫苗和预防性或先发制人的抗病毒治疗。在移植后早期识别潜在的危险因素可能有助于更好地制定预防措施,从而降低感染率。

2 感染的危险因素

肝移植术后感染的危险因素很多,综合最新的文献综述可分为术前、术中、术后因素。

2.1 术前因素

术前供受体BMI指数的差异容易造成移植术后手术部位感染的发生[45]。也有研究表明供体IL-8基因多态性、C7基因型是肝移植患者早期细菌感染和死亡的重要独立危险因素[46,47]。另一方面,活体供肝移植相对于死亡供肝移植术后侵袭性真菌感染的风险更高[48]。在接受血清病毒阳性器官的血清病毒阴性患者的高危人群中,女性性别与迟发性巨细胞病毒感染的发生存在显著关联[49]

术前受体的原发性疾病也容易造成移植术后感染,尤其在终末期肝病或重度肝硬化受者,肝硬化和门静脉高压症直接增加肠道通透性,间接影响肠道菌群,促进了肠道菌群移位,从而导致感染[50]。因此术前对该类患者应该予以提高重视,必要时术后早期应用抗生素。

术前CHILD分级和MELD评分是两种广泛应用的肝移植预后模型[51]MELD评分高、Pugh C级和腹水反映了潜在肝病的严重程度及其相关的免疫功能障碍,这些都是导致移植后血流感染(BSI)出现的原因[52-54]。因此应加强 MELD 评分高、Pugh C级或腹水较高多受体感染的监测和预防。其他因素如术前COPD、高血糖水平、营养不良、肝性脑病也容易造成移植术后感染[55]

2.2 术中因素

术中大量失血及输血量的增多是移植术后BSI危险因素[52],因为大量输血会导致输血相关的免疫功能障碍从而增加感染风险,与此同时,接受肝移植手术的患者由于先前存在的肝功能障碍和术中及术后凝血功能障碍而有失血的风险[56]。因此为了防止大量的手术失血,关键是在肝移植过程中谨慎的手术操作和在整个移植过程中纠正凝血功能异常。

手术时间长是移植受者BSI的另一个危险因素[52,57]。一般情况下,随着手术时间的延长,手术部位组织损伤加重、腹腔暴露时间延长,增加了血流感染发生的机会。这一危险因素可以通过提高外科医生的手术技能来改善。其他的如术中应用Roux-Y胆总管空肠吻合术、术中肝脏冷缺血时间的延长、再次移植等也是术后感染的危险因素[54,58]

2.3 术后因素

术后重症监护病房(ICU)住院时间长是移植后感染的重要因素。一般来说,ICU病房感染的发病率比非ICU病房的发病率高,主要是因为ICU患者疾病的严重性和更多的侵入性设备使用[55,59],甚至是大量抗菌药物的使用。在评估肝移植患者血流感染来源的研究中,导管相关感染是最常见的感染之一,如气管插管、中心静脉置管等,因此术后创造机会早期拔管及中心静脉置管的无菌流程护理至关重要[60]

术后急性排斥反应亦是移植术后发生血流感染的危险因素。排斥反应容易导致术后移植物功能障碍,从而需要更强的免疫抑制治疗来抑制抗体介导的排斥反应,而过度使用免疫抑制剂可能导致细胞免疫功能障碍,容易导致多种感染的发生。其他的如术后胆道狭窄并发症、术后急性肾损伤、频繁血透、术后高血糖水平等亦有研究表明与术后感染有关[45,54,57]

3 总结与展望

对于肝移植受者任何感染的防治应把握三大原则:①根据免疫功能监测,个体化调节免疫抑制强度;②加强支持治疗,包括营养、球蛋白、白蛋白等的补充支持;③选用合适的抗感染药物,不同研究中心的病原体分布及术后感染率呈现差异性,这可能与地区间医疗水平、病原流行病学等差异有关;④在术前、术中及移植后,应尽量减少上述可控的危险因素,以预防感染。

参考文献

[1] Aravinthan AD,Bruni SG,Doyle AC,et al.Liver transplanta-tion is a preferable alternative to palliative therapy for selected patients with advanced hepatocellular carcinoma[J].Ann Surg Oncol,2017,24(7):1843-1851.

[2] Imai D,Yoshizumi T,Sakata K,et al.Long-term outcomes and risk factors after adult living donor liver transplantation[J].Transplantation,2018,102(9):e382-e391.

[3] Vera A,Contreras F,Guevara F.Guevara,Incidence and risk factors for infections after liver transplant:single-center experi-ence at the University Hospital Fundación Santa Fe de Bogotá,Colombia[J].Transpl Infect Dis,2011,13(6):608-615.

[4] Fishman JA.Infections in immunocompromised hosts and organ transplant recipients:Essentials[J].Liver Transpl,2011,17(Suppl 3):S34-37

[5] Kim YJ,Kim SI,Wie SH,et al.Infectious complications in liv-ing-donor liver transplant recipients:a 9-year single-center ex-perience[J].Transpl Infect Dis,2008,10(5):316-324.

[6] Varghese J,Gomathy N,Rajashekhar P,et al.Perioperative bacterial infections in deceased donor and living donor liver transplant recipients[J].J Clin Exp Hepatol,2012,2(1):35-41.

[7] Bert F,Larroque B,Paugam-Burtz C,et al.Microbial epidemi-ology and outcome of bloodstream infections in liver transplant recipients:an analysis of 259 episodes[J].Liver Transpl,2010,16(3):393-401.

[8] Munoz-Price LS,Poirel L,Bonomo RA,et al.Clinical epidemi-ology of the global expansion of Klebsiella pneumoniae carbap-enemases[J].Lancet Infect Dis,2013,13(9):785-796.

[9] Zhong L,Men TY,Li H,Peng ZH,et al.Multidrug-resistant gram-negative bacterial infections after liver transplantation-Spectrum and risk factors[J].J Infect,2012,64(3):299-310.

[10] Paterson DL,Singh N,Rihs JD,et al.,Control of an outbreak of infection due to extended-spectrum beta-lactamase--produc-ing Escherichia coli in a liver transplantation unit[J].Clin In-fect Dis,2001,33(1):126-128.

[11] Reddy P,Zembower TR,Ison MG,et al.Carbapenem-resistant-Acinetobacter baumannii infections after organ transplantation[J].Transpl Infect Dis,2010,12(1):87-93.

[12] Russell DL,Flood A,Zaroda TE,et al.Outcomes of coloniza-tion with MRSA and VRE among liver transplant candidates and recipients[J].Am J Transplant,2008,8(8):1737-1743.

[13] Gearhart M,Martin J,Rudich S,et al.Consequences of vanco-mycin-resistant Enterococcus in liver transplant recipients:a matched control study[J].Clin Transplant,2005,19(6):711-716.

[14] Dobbs TE,Patel M,Waites KB,et al.Nosocomial spread of en-terococcus faecium resistant to vancomycin and linezolid in a Tertiary Care Medical Center[J].J Clin Microbiol,2006,44(9):3368-3370.

[15] Torre-Cisneros J,Herrero C,Cañas E,et al.High mortality re-lated with staphylococcus aureus bacteremia after liver trans-plantation[J].Eur J Clin Microbiol Infect Dis,2002,21(5):385-388.

[16] Garzoni C,AST Infectious Diseases Community of Practice.Multiply resistant gram-positive bacteria methicillin-resistant,vancomycin-intermediate and vancomycin-resistant staphylococ-cus aureus(MRSA,VISA,VRSA)in solid organ transplant re-cipients[J].Am J Transplant,2009,9 Suppl 4:S41-49.

[17] Sganga G,Bianco G,Frongillo F,et al.Fungal infections after liver transplantation:incidence and outcome[J].Transplant Proc,2014,46(7):2314-2318.

[18] Pappas PG,Alexander BD,Andes DR,et al.Invasive fun-gal infections among organ transplant recipients:results of the transplant-associated infection surveillance network(TRANSNET)[J].Clin Infect Dis,2010,50(8):1101-1111.

[19] Andes DR,Safdar N,Baddley JW,et al.The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States:results of the Transplant-Associ-ated Infection Surveillance Network(TRANSNET)[J].Transpl Infect Dis,2016,18(6):921-931.

[20] Aberg F,Mäkisalo H,Höckerstedt K,Isoniemi H.Infectious complications more than 1 year after liver transplantation:a 3-decade nationwide experience[J].Am J Transplant,2011,11(2):287-295.

[21] Aslam S,Rotstein C2;AST Infectious Disease Community of Practice.Guidelines from the American Society of Transplanta-tion Infectious Diseases Community of Practice[J].Clin Trans-plant,2019:e13623.

[22] Nagao M,Fujimoto Y,Yamamoto M,et al.Epidemiology of in-vasive fungal infections after liver transplantation and the risk factors of late-onset invasive aspergillosis[J].J Infect Chemoth-er,2016,22(2):84-89.

[23] Barchiesi F,Mazzocato S,Mazzanti S,et al.Invasive aspergil-losis in liver transplant recipients:Epidemiology,clinical char-acteristics,treatment,and outcomes in 116 cases[J].Liver Transplantat,2015,21(2):204-212.

[24] Silveira FP,Kusne S;AST Infectious Diseases Community of Practice.Candida infections in solid organ transplantation[J].Am J Transplantat,2013,13(s4):220-227.

[25] Kim SI.Bacterial infection after liver transplantation[J].World J Gastroenterol,2014,20(20):6211-6220.

[26] Clancy CJ,Nguyen MH.Nguyen,finding the“missing 50%”of invasive candidiasis:how nonculture diagnostics will improve understanding of disease spectrum and transform patient care[J].Clin Infect Dis,2013,56(9):1284-1292.

[27] Liu X,Ling Z,Li L,Ruan B.Invasive fungal infections in liver transplantation[J].Int J Infect Dis,2011,15(5):e298-304

[28] Pacholczyk M,Lagiewska B,Lisik W,et al.Invasive fungal in-fections following liver transplantation risk factors,incidence and outcome[J].Ann Transplant,2011,16(3):14-16.

[29] Vazquez JA,Miceli MH,Alangaden G.Invasive fungal infec-tions in transplant recipients[J].Ther Adv Infect Dis,2013,1(3):85-105.

[30] Saliba F,Delvart V,Ichaï P,et al.Fungal infections after liver transplantation:outcomes and risk factors revisited in the MELD era[J].Clin Transplant,2013,27(4):E454-E461.

[31] Qin J,Fang Y,Dong Y,et al.Radiological and clinical find-ings of 25 patients with invasive pulmonary aspergillosis:retro-spective analysis of 2150 liver transplantation cases[J].Br J Radiol,2012,85(1016):e429-e435.

[32] Neofytos D,Fishman JA,Horn D,et al.Epidemiology and out-come of invasive fungal infections in solid organ transplant recip-ients[J].Transpl Infect Dis,2010,12(3):220-229.

[33] Singh N,Forrest G;AST Infectious Diseases Community of Practice.Cryptococcosis in Solid Organ Transplant Recipients[J].Am J Transplant,2009,9(Suppl 4):S192-198.

[34] Kullberg BJ,Arendrup MC.Invasive Candidiasis[J].New Engl J Med,2015,373(15):1445-1456.

[35] Smith RM,Schaefer MK,Kainer MA,et al.Fungal infections associated with contaminated methylprednisolone injections[J].New Engl J Med,2013,369(17):1598-1609.

[36] Husain S,Wagener MM,Singh N.Cryptococcus neoformans in-fection in organ transplant recipients:variables influencing clin-ical characteristics and outcome[J].Emerg Infect Dis,2001,7(3):375-381.

[37] Sun HY,Wagener MM,Singh N.Cryptococcosis in solid-or-gan,hematopoietic stem cell,and tissue transplant recipients:evidence-based evolving trends[J].Clin Infect Dis,2009,48(11):1566-1576.

[38] Freeman RB Jr.The‘Indirect’Effects of Cytomegalovirus Infec-tion[J].Am J Transplant,2009,9(11):2453-2458.

[39] Bruminhent J,Razonable RR.Management of cytomegalovirus infection and disease in liver transplant recipients[J].World J Hepatol,2014,6(6):370-383.

[40] Kotton CN,Kumar D,Caliendo AM,et al.Updated internation-al consensus guidelines on the management of cytomegalovirus in solid-organ transplantation[J].Transplantation,2013,96(4):333-360.

[41] Yadav SK,Saigal S,Choudhary NS,et al.Cytomegalovirus in-fection in liver transplant recipients:current approach to diagno-sis and management[J].J Clin Exp Hepatol,2017,7(2):144-151.

[42] Zuckerman R,Wald A;AST Infectious Diseases Community of Practice.Herpes simplex virus infections in solid organ trans-plant recipients[J].Am J Transplant,2009,9(Suppl 4):S104-107.

[43] Simakachorn L,Tanpowpong P,Lertudomphonwanit C,et al.Various initial presentations of Epstein-Barr virus infection-asso-ciated post-transplant lymphoproliferative disorder in pediatric liver transplantation recipients:Case series and literature re-view[J].Pediatr Transplant,2019,23(2):e13357.

[44] Zhang J,Ren B,Hui R,et al.Clinical heterogeneity of human parvovirus B19 infection following adult liver transplantation[J].Medicine,2018,97(34):e12074.

[45] Oliveira RA,Mancero JMP,Faria DF,Poveda VB.A retrospec-tive cohort study of risk factors for surgical site infection follow-ing liver transplantation[J].Prog Transplant,2019,29(2):144-149.

[46] Shi BJ,Yu XY,Li H,et al.Association between donor and re-cipient Interleukin-18 gene polymorphisms and the risk of infec-tion after liver transplantation[J].Clin Invest Med,2017,40(5):E176-E187.

[47] Zhong L,Li H,Li Z,et al.C7 genotype of the donor may pre-dict early bacterial infection after liver transplantation[J].Sci Rep,2016,6:24121.

[48] Eschenauer GA,Kwak EJ,Humar A,et al.Targeted versus universal antifungal prophylaxis among liver transplant recipi-ents[J].Am J Transplant,2015,15(1):180-189.

[49] Busch CJ,Siegler BH,Werle H,et al.Risk factors for early vi-ral infections after liver transplantation[J].Langenbecks Arch Surg,2018,403(4):509-519.

[50] Mu J,Chen Q,Zhu L,et al.Influence of gut microbiota and in-testinal barrier on enterogenic infection after liver transplanta-tion[J].Curr Med Res Opin,2019,35(2):241-248.

[51] Genda T,Ichida T,Sakisaka S,et al.Survival in patients with Child-Pugh class C cirrhosis:Analysis of the liver transplant registry in Japan[J].Hepatol Res,2017,47(11):1155-1164.

[52] He Q,Liu P,Li X,et al.Risk factors of bloodstream infections in recipients after liver transplantation:a meta-analysis[J].In-fection,2019,47(1):77-85.

[53] Lim S,Kim EJ,Lee TB,et al.Predictors of postoperative infec-tious complications in liver transplant recipients:experience of 185 consecutive cases[J].Korean J Intern Med,2018,33(4):798-806.

[54] Abad CL,Lahr BD,Razonable RR.Epidemiology and risk fac-tors for infection after living donor liver transplantation[J].Liv-er Transpl,2017,23(4):465-477.

[55] Laici C,Gamberini L,Bardi T,et al.Early infections in the in-tensive care unit after liver transplantation-etiology and risk fac-tors:A single-center experience[J].Transpl Infect Dis,2018,20(2):e12834.

[56] Tischer S,Miller JT.Pharmacologic strategies to prevent blood loss and transfusion in orthotopic liver transplantation[J].Cri Care Nurs Q,2016,39(3):267-280.

[57] Furuichi M,Fukuda A,Sakamoto S,et al.Characteristics and risk factors of late-onset bloodstream infection beyond 6 months after liver transplantation in children[J].Pediatr Infect Dis J,2018,37(3):263-268.

[58] Freire MP,Soares Oshiro IC,Bonazzi PR,et al.Surgical site in-fections in liver transplant recipients in the model for end-stage liver disease era:An analysis of the epidemiology,risk factors,and outcomes[J].Liver Transpl,2013,19(9):1011-1019.

[59] Doyle JS,Buising KL,Thursky KA,et al.Epidemiology of in-fections acquired in intensive care units[J].Semin Respir Crit Care Med,2011,32(2):115-138

[60] Hassan EA,Elsherbiny NM,Abd El-Rehim AS,et al.Health care-associated infections in pre-transplant liver intensive care unit:Perspectives and challenges[J].J Infect Public Health,2018,11(3):398-404.

Epidemiological characteristics and risk factors of infection after liver transplantation

ZHONG Si-quan1,CHEN Wei-qiang2

1.Guangdong Medical University Postgraduate College,Zhanjiang ,Guangdong 524000,China;2.Department of Hepatobiliary Surgery,Zhongshan People's Hospital,Zhongshan,Guangdong 528400,China

[Abstract] At present,liver transplantation(LT)has become the recommended treatment for patients with end-stage liver disease and advanced liver cancer.Its 5-year survival rate is close to 60%-80%,but infection is still the main reason affecting the survival rate of patients after liver transplantation.This article will review the etiological characteristics and risk factors of infection after liver transplantation in order to increase the awareness of post-operative infection.

[Key words] liver transplantation;bacterial infection;fungal infection;virus infection;risk factor

doi:10.3969/j.issn.1009-976X.2020.01.024

中图分类号:R617

文献标识码:A

作者单位:1.广东医科大学研究生学院,广东湛江524000;2.中山市人民医院肝胆外科,广东中山528400

*通讯作者:陈伟强,Email:cwq20138@aliyun.com

Corresponding author:CHEN Wei-qiang,cwq20138@aliyun.com

(收稿日期:2019-10-08)

关键词: 病毒感染, 真菌感染, 肝移植, 危险因素, 细菌感染

Abstract: [Abstract] At present, liver transplantation (LT) has become the recommended treatment for patients with end-stage liver disease and advanced liver cancer. Its 5-year survival rate is close to 60%-80%, but infection is still the main reason affecting the survival rate of patients after liver transplantation. This article will review the etiological characteristics and risk factors of infection after liver transplantation in order to increase the awareness of post-operative infection.

Key words: liver transplantation, bacterial infection, virus infection, risk factor, fungal infection

中图分类号: