Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates.

Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0-1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.

Déclaration de conflit d'intérêts

Philip G. Ferstl, Consultancies: SNIPR Biome. Wolf O. Bechstein: Consultancies/speaker fees: Astellas, Chiesi, Gore Deutschland, Medupdate GmbH, MCI, MCN, Novartis. Michael Hogardt, Grants: Gilead, Kirmser Foundation, German CF Foundation; Speaker’s fees: Thieme Science, Chiesi GmbH. Haitham Mutlak, Speaker’s fees: Orion Pharma, Löwenstein Medical, Pfizer, Getinge. Christoph Stephan, Speaker’s fees: AbbVie, LÄK-Hessen, Gilead, Hexal, Janssen, MSD, Pfizer, Roche, TAD, ViiV; Consultancies: AbbVie, Gilead, Janssen, MSD, ViiV. Nina Weiler, Consultancy: Astellas and Novartis, Travel support: AbbVie, Astellas, Biotest, and Novartis. Jonel Trebicka, Speaker’s fees and/or consultancies: Gore, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis, and Martin Pharmaceutical. Stefan Zeuzem: Speaker’s fees: Abbvie, Gilead, Merck/MSD, Consultancy: Abbvie, Gilead, Intercept, Janssen. Oliver Waidmann, Consultancies: Amgen, Bayer, BMS, Celgene, Eisai, Incyte, Ipsen, Merck Serono, MSD, Novartis, Roche, Servier, Shire; Speaker’s fees: Bayer, BMS, Celgene, Eisai, Ipsen, Novartis, Roche, Shire; Travel support: Abbvie, Bayer, BMS, Gilead, Ipsen, Merck; Grants: Basilea, Incyte, Else Kröner-Fresenius-Stiftung, Medac, Merck Serono, MSD. Martin-Walter Welker, Consultancies / speaker’s fees: AbbVie, Amgen, Bayer, Chiesis, BMS, Gilead, Novartis, Roche; Travel Support: AbbVie, Astellas, Bayer, BMS, Novartis, Janssen, Roche. This does not alter our adherence to PLOS ONE policies on sharing data and materials.