Risk of postoperative infection after liver transplantation: A univariate and stepwise logistic regression analysis of risk factors in 150 consecutive patients

Between March 1988 and December 1989, 180 orthotopic liver transplants were performed in 150 adult patients. We have retrospectively reviewed all charts to determine incidence, timing and etiology of major postoperative infections. Major postoperative infection occurred during the 90-day period following transplantation in 47% of liver transplant patients. Bacterial infections dominated early, while viral and protozoal infections presented later. The most common organisms were Staphylococcus, Enterococcus, and cytomegalovirus. Significant variables associated with infection included pretransplant status, preoperative renal dysfunction, rejection, OKT3 therapy, postoperative renal and liver graft dysfunction, and amount of blood products transfused. By using a stepwise logistic regression analysis, we determined that the best predictors of postoperative infection were rejection and postoperative transfusion requirements. This study emphasizes the need to develop newer immunosuppressive strategies to prevent rejection, but more importantly reemphasizes the critical importance of surgical technique.