The impact of spontaneous bacterial peritonitis on patient outcomes after liver transplantation using the scientific registry of transplant recipient (SRTR) database. Am J Transplant 2018; 18:843.
Moonka D, Divine G, and Nagai S. The impact of spontaneous bacterial peritonitis on patient outcomes after liver transplantation using the scientific registry of transplant recipient (SRTR) database. Am J Transplant 2018; 18:843.
Am J Transplant
Spontaneous bacterial peritonitis (SBP) is associated with abdominal inflammation and increased morbidity in patients with end-stage liver disease. However, SBP has generally not been associated with worse outcomes after liver transplantation (LT) in single center studies. In this analysis, we analyze the impact of a history of SBP on LT outcomes using the SRTR database. METHODS: All patients, 18 years or older, who received an initial LT alone between March 2002 and December 2016 were included leaving 75,576 patients. 2262 were missing SBP data leaving 73,314. Of these 4665 had SBP and 68,649 did not. The two groups were compared for patient and donor characteristics. Groups were compared for length of stay (LOS) and survival using Kaplan-Meier analyses with log rank test. Multivariate analysis was done using Cox regression analysis. RESULTS: Patients with a history of SBP were more ill than those without. They had a higher MELD at LT (26.1 + 10.0 vs 20.7 + 10.3: P<0.001), a higher creatinine (1.69 + 1.23 vs 1.34 + 1.04: P<0.001) and were more likely to be on dialysis (15% vs 7%: P<0.001). They were more likely to be hospitalized (28% vs 16%: P<0.001) or in the ICU (16% vs 11%: P<0.001). They were more likely to have portal vein thrombosis (13% vs 9%: P<0.001) and less likely to have HCC (11% vs 28%). They had an equal incidence of hepatitis C (44% vs 43%). Patients with SBP had longer LOS in days (17.2 + 19.9 vs 14.8 + 18.9: P<0.001). Patients with SBP had worse patient survival at 3 month (94.4% vs 95.1%: P=0.026), 1 year (87.6% vs 90.0%: P<0.001) and 3 year (80.0% vs 81.8%: P=0.001). SBP was not associated with worse graft survival. On univariate analysis, SBP was associated with increased LOS (HR 1.20: 95% CI 1.16-1.23: P<0.001) and diminished patient survival (HR 1.09: 95% CI 1.03-1.016: P=0.002). However on multivariate analysis, SBP was no longer associated with either patient death or increased LOS. CONCLUSIONS: Patients with a history of SBP prior to transplant are considerably more ill than patients without an SBP history and have worse patient survival and longer length of stay. However, when controlling for other medical comorbidities, SBP alone is not associated with worse patient outcomes.