Bloodstream Infections (BSI) in Patients Undergoing Liver Transplantation (LT) for Hilar Cholangiocarcinoma (CCA).: Abstract# A389

Background: BSI are common complications after LT, especially in the early post-operative period. Data regarding the epidemiology of post-transplant BSI in patients with CCA who underwent LT after neoadjuvant chemoradiotherapy are non-existent. Objectives: We describe the epidemiology and assess the risk factors for post-transplant BSI and their impact on patient and allograft survival after LT for CCA. Methods: We conducted a retrospective cohort study of patients who underwent neoadjuvant chemo-radiotherapy followed by LT for CCA at our institution between 2004 and 2012. Results: A total of 124 patients were studied. A total of 67 BSI occurred in 43 (35%) patients. The majority of BSI were due to bacteria (n=65, 97%), followed by fungi (n=7, 10%). 21 (31%) were polymicrobial; 58 (88%) were secondary BSI. The most common concurrent infections were intra-abdominal (n=29, 43%) followed by pneumonia (n=3, 5%) and skin and soft tissue infections (n=3, 5%). Gram positive cocci (n=45, 69%) were the most common agents followed by Gram negative bacilli (n=28, 43%). Among Gram positive cocci, Enterococcus sp. (n=31, 69%), coagulase negative staphylococcus (n=10, 22%) and Viridans group Streptococcus (n=8, 18%) were the common agents. Majority of the Gram negative infections were caused by Klebsiella sp (n=13, 46%), Pseudomonas (n=4, 14%), E. coli (n=4, 14%) and Bacteroides (n=4, 14%). Fungal BSI were due to Candida albicans (n=3, 43%), C. glabrata (n=3, 43%) and Saccharomyces (n=1, 14%). On multivariable analysis, risk factors for post-transplant BSI were graft ischemia (HR=17.8, P<0.001), post-LT biliary stricture (6.5, 0.004) and recipient VRE colonization (4, <0.001). Post-LT BSI was not associated with allograft failure (P=0.09) or patient mortality (P=0.26). Conclusion: Post-transplant BSI are an important cause of morbidity after LT for CCA. Graft ischemia, post-LT biliary stricture and VRE colonization were independent risk factors. BSI was not associated with allograft failure or patient mortality.