Perioperative infection control in liver transplantation

Abstract

Infection and malnutrition are often associated with patients undergoing livertransplantation (LT) . We clarified that preoperative malnutrition was an independent risk factor for sepsis, and death due to infection after LT. There-fore, perioperative nutritional intervention is crucial to improve outcomes after LT. In the present review article, we would like to introduce our efforts to reduce infection and improve outcomes after LT focusing on nutrition and body composition. We established bundled strategy against postoperative infection LT consisting of 4factors: 1) Revised criteria for LT, 2) Increased hand hygiene compliance rate and contact precautions, 3) Aggressive periop-erative nutritional and rehabilitation intervention, and 4) Procalcitonin measurement for more precise determination of bacterial infection. After implementation of this bundled strategy, incidence ofbacteremia (P=0.02), detection rate of multiple bacteria (P=0.01) and deaths from infections (P=0.04) were significantly reduced. Most recently, we have implemented new criteria for LT considering body composition：to exclude patients who have low skeletal muscle mass, muscle steatosis, and visceral adiposity together. After implementation of the new criteria, 1-year overall survival was 98％. In conclusion, the bundled strategy and new criteria for LT considering body composition are useful in preventing infections and lengthening overall survival after LT.