{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:02:02Z","timestamp":1792450922176,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cirrhotic patients are highly exposed to healthcare services and antibiotics. Although pre\u2010liver transplantation (LT) infections are directly related to the worsening of liver function, the impact of these infections on LT outcomes is still unclear. This study aimed to identify the effect of multidrug\u2010resistant microorganism (MDRO) infections before LT on survival after LT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective study that included patients who underwent LT between 2010 and 2019. Variables analyzed were related to patients\u2019 comorbidities, underlying diseases, time on the waiting list, antibiotic use, LT surgery, and occurrences post\u2010LT. Multivariate analyses were performed using logistic regression, and Cox regression for survival analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 865 patients were included; 351 infections were identified in 259 (30%) patients, of whom 75 (29%) had \u22651 pre\u2010LT MDRO infection. The most common infection was spontaneous bacterial peritonitis (34%). The agent was identified in 249(71%), 53(15%) were polymicrobial. The most common microorganism was <jats:italic>Klebsiella pneumoniae<\/jats:italic> (18%); the most common MDRO was ESBL\u2010producing Enterobacterales (16%), and carbapenem\u2010resistant (CR) Enterobacterales (10%). Factors associated with MDRO infections before LT were previous use of therapeutic cephalosporin (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.001) and fluoroquinolone (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.001), SBP prophylaxis (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.03), ACLF before LT (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.03), and days of hospital stay pre\u2010LT (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001); HCC diagnosis was protective (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.01). Factors associated with 90\u2010day mortality after LT were higher MELD on inclusion to the waiting list (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.02), pre\u2010LT MDRO infection (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.04), dialysis after LT (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), prolonged duration of LT surgery (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), post\u2010LT CR\u2010Gram\u2010negative bacteria infection (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), and early retransplantation (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MDRO infections before LT have an important impact on survival after LT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15173","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T14:38:34Z","timestamp":1698244714000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pre\u2010transplant multidrug\u2010resistant infections in liver transplant recipients\u2010epidemiology and impact on transplantation outcome"],"prefix":"10.1111","volume":"38","author":[{"given":"Gabriela T.","family":"Lemos","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora R. B.","family":"Terrabuio","sequence":"additional","affiliation":[{"name":"Division of Clinical Gastroenterology and Hepatology Hospital das Cl\u00ednicas, Department of Gastroenterology of University of S\u00e3o Paulo School of Medicine  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7525-3238","authenticated-orcid":false,"given":"Nathalia N.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice T. W.","family":"Song","sequence":"additional","affiliation":[{"name":"Division of Liver and Gastrointestinal Transplant Hospital das Cl\u00ednicas Department of Surgery University of S\u00e3o Paulo School of Medicine  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel C. V.","family":"Oshiro","sequence":"additional","affiliation":[{"name":"Working Committee for Hospital Epidemiology and Infection Control University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Augusto C.","family":"D'Albuquerque","sequence":"additional","affiliation":[{"name":"Division of Liver and Gastrointestinal Transplant Hospital das Cl\u00ednicas Department of Surgery University of S\u00e3o Paulo School of Medicine  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna S.","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edson","family":"Abdala","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9691-192X","authenticated-orcid":false,"given":"Maristela P.","family":"Freire","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"},{"name":"Working Committee for Hospital Epidemiology and Infection Control University of S\u00e3o Paulo School of Medicine Hospital das Cl\u00ednicas  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.013"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2021.01.006"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.005"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11020232"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001620"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2018.04.039"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13673"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2018.03.040"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab109"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.12659\/AOT.921591"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20100691.2011.03570.x"},{"key":"e_1_2_8_14_1","unstructured":"CDC\/NHSN.CDC\/NHSN Surveillance Definitions for Specific Types of Infections. 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