Comparative analysis of early post-transplant infections after DCD with hypothermic oxygenated liver perfusion and DBD liver transplantation: A retrospective cohort study.

Liver transplantation outcomes have improved. However, immunosuppression also raises infection susceptibility. Potential differences in infections between donation after circulatory death (DCD) and donation after brain death (DBD) recipients remain unclear. This study analyzed postoperative infections and compared their incidence between DCD and DBD recipients. Patients undergoing liver transplantation from January 1, 2016, to December 31, 2022, were included. DCD and marginal DBD liver grafts underwent hypothermic oxygenated machine perfusion (HOPE). Bacterial, viral, and fungal infections were identified using standardized definitions. Infections were categorized into periods: 0-2 weeks (period 1), 3-4 weeks (period 2), 1-6 months (period 3), and beyond 6 months (period 4). The primary outcome was the occurrence of infection within the first post-transplant year, including pathogen spectrum, timing, and infection site. The secondary outcome was the assessment of infection risk factors investigated with Poisson regression. A total of 300 liver transplants were included. In all, 42.8% of DBD recipients and 44.3% of DCD recipients suffered from at least 1 infection. In total, 298 relevant infections occurred, with bacteria accounting for 73.2% in DBD and 86.4% in DCD recipients. Bacterial infections predominated in all periods. In periods 1 and 2, bloodstream infections, abdominal and surgical site infections were most frequent, while liver-related infections, especially in DCD, and bloodstream infections dominated in periods 3 and 4. Viral and fungal infections were less frequent. One-year survival was 87.1% for DBD and 87.7% for DCD recipients. Poisson regression identified DCD recipients (IRR 1.99, 95% CI 1.37-2.92, p