Identifying a targeted population at high risk for infections after liver transplantation in the MELD era

Impact of model for end-stage liver disease (MELD) scoring system on post-transplant infections and associated risk factors are unknown. Infections < 90 d post-transplant were assessed in 277 consecutive liver transplant recipients from 1999 to 2008. "High-risk" factors for infections were pre-defined as MELD score > 30, ICU stay > 48 h prior to transplant, intraoperative transfusion >= 15 units, retransplantation, post-transplant dialysis, or reoperation. Of the 240 recipients in the MELD era (2002-2008), 48.5% had any high-risk factor. The OR for infection was 1.69, 2.00, 18.00, and 4.50 in recipients with any 1, 2, 3, and >= 4 high-risk factors, respectively (chi 2 for trend, p < 0.001). In logistic regression model, recipient age (OR 1.12, p < 0.05) and any high-risk factor (OR 2.42, p < 0.05) were associated with infections. Compared with 37 pre-MELD recipients, the overall infections and mortality at 12 months did not differ in the two eras. In Cox regression model, recipient age (OR 1.09, p < 0.05) and any high-risk factor (OR 2.42, p < 0.05) remained associated with infections. The overall frequency of infections did not increase in the MELD era. Pre-defined risk factors accurately predicted the risk of infections in these patients.