Posttransplantation dialysis-associated infections: Morbidity and impact on outcome in liver transplant recipients

The aim of this study is to assess the predictors, impact on infectious mor bidity, and outcome of posttransplantation dialysis in liver transplant rec ipients and to compare the results with data from patients who did not requ ire dialysis after transplantation. The study sample included 176 consecuti ve patients undergoing liver transplantation; the median follow-up was 4.3 years. All patients were administered tacrolimus as primary immunosuppressi on. Overall, 16% (28 of 176 patients) of the patients required dialysis aft er transplantation. Patients requiring dialysis had significantly greater p retransplantation creatinine levels (2.4 v 1.2 mg/dL; P = .009), were more likely to require pretransplantation dialysis (21% v 1%; P = .0001), and ha d a greater rate of biopsy-proven rejection episodes (50%, 14 of 28 episode s v 20%, 30 of 148 episodes; P = .0009) and longer posttransplantation inte nsive care unit lengths of stay (P = .0001). The incidence of infections (9 1% v 41%; P = .0001) and episodes of infection per patient (2.4 v 0.7 episo des; P = .0001) were significantly greater in patients undergoing dialysis compared with those not undergoing dialysis. There was no difference in the frequency of cytomegalovirus (CMV) infection or disease; however, bacteria l infections (87% v 31%; P = .0001) and invasive fungal infections (39% v 7 %; P = .0001) were significantly more likely to occur in patients requiring dialysis. In logistic regression, dialysis (P = .0006) and CMV infection ( P = .007) were independent significant predictors of major infections. Over all survival (assessed by Kaplan-Meier probability) was less in patients un dergoing dialysis compared with those not undergoing dialysis (P = .0001). Among dialyzed patients, only 10% of those who survived had an invasive fun gal infection compared with 46% of those who died (P = .08); 5 of 6 patient s died within 1 month of the fungal infection. The need for dialysis porten ded a grave outcome in liver transplant recipients and identified a subgrou p of patients at a significantly greater risk for major infections, particu larly fungal infections, after liver transplantation.