Risk Factors for Infections in Patients Undergoing Liver Transplantation (LT) for Hilar Cholangiocarcinoma (CCA).: Abstract# A392

Background: Hilar CCA has emerged as an indication for LT when administered in conjunction with aggressive neoadjuvant chemoradiotherapy. Data regarding the risk factors for infections in this population are non-existent. Objectives: This study aims to describe the risk factors for any infection in LT recipients with biopsy proven CCA. Methods: A retrospective cohort study was conducted of patients who underwent chemoradiotherapy followed by LT for CCA at our institution between 2004 and 2012. All patients were reviewed from six months prior to LT until the last date of follow up. Results: A total of 124 patients were studied. The mean follow-up duration was 4.2 years. A total of 255 infections occurred in 105 (85%) patients. The median time to first infection was 15 weeks (range 0 to 9.1 years). The majority of infections were due to bacteria (n=121, 47%), followed by viruses (n=34, 13%) and fungi (n=29, 11%). Ninety (35%) were microbiologically indeterminate; while 42 (17%) were polymicrobial. The most common sites were the abdomen (abscesses, peritonitis, cholangitis and colitis) (n=135, 53%), bloodstream (n=67, 26%) and musculoskeletal system (n=33, 13%). On multivariate analysis, risk factors for the outcome of time to first post-transplant infection were recipient VRE colonization (Hazard Ratio 1.9, P=0.002), living donor LT (6.6, <0.001), longer cold ischemia time (1.05,<0.001), donor CMV seropositivity (2.2, <0.001), post-LT hepatic artery thrombosis (2.6, 0.005), biliary stricture (3.8, 0.002), intra-abdominal fluid collection (4.2, <0.001), and higher number of reoperations within 1 month after transplantation (1.7, 0.02). Conclusion: Infections are a major cause of morbidity after LT for CCA. Living donor LT, VRE colonization, re-operations within 1 month post-LT, postoperative complications (hepatic artery thrombosis, abdominal fluid collection, biliary stricture) and donor CMV seropositivity were independent risk factors for infection in LT recipients with CCA.