Risk Factors for Bacterial Infection After Liver Transplant: A Systematic Review and Meta-Analysis

Objectives: Bacterial infection is an important cause of early death after liver transplant. This meta-analysis aimed to determine the risk factors for bacterial infection after liver transplant. Materials and Methods: We searched for relevant studies published in PubMed, Web of Science, Embase, The Cochrane Library, China National Knowledge Infrastructure, Wan Fang Database, Chinese Science and Technology Journal Database, and China Biomedical Literature Database up to May 2024. After literature screening, we used the Newcastle-Ottawa Scale to evaluate the quality of included studies. The fixed-effect or random-effect model was used to calculate the combined odds ratio and corresponding 95% CI. We used the I2 test to evaluate whether there was heterogeneity among studies. Results: The 23 included articles reported on 6426 adult liver transplant patients and 1427 cases of bacterial infection. Preoperative hepatic encephalopathy (odds ratio = 2.55; 95% CI, 1.48-4.41), Model for End-Stage Liver Disease score (odds ratio = 2.09; 95%CI, 1.10-3.97), Child-Pugh C score (odds ratio = 4.87; 95% CI, 3.22-7.37), hypoproteinemia (odds ratio = 2.88; 95% CI, 1.84-4.50), use of antibiotics (odds ratio = 3.62; 95% CI, 1.83-7.17), intraoperative blood transfusion (odds ratio = 2.14; 95%CI, 1.04-4.38), intraoperative bleeding (odds ratio = 2.74; 95% CI, 1.53-4.90), ventilator time (odds ratio = 3.24; 95% CI, 1.88-5.57), stay in intensive care unit (odds ratio = 5.17; 95% CI, 3.35-7.99), and hospitalization time (odds ratio = 1.03; 95%CI, 3.06-7.61) were influencing factors but not age. Conclusions: Further strict and well-designed studies with sufficient sample size are needed to identify risk factors to address the limitations of our study. Strengthening the assessment and screening of risk factors and effective intervention as soon as possible are conducive to improving the clinical outcomes of liver transplant recipients.