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Peer-reviewedCC BYDiseases (Basel, Switzerland)

The Impact of Pre- Versus Post-Transplant Multidrug-Resistant Organism Colonization on Liver Transplant Outcomes: A Retrospective Cohort Study.

  • Emil Aliev1,2
  • Efrat Orenbuch-Harroch3,4,5
  • Abed Khalaileh4,6
  • Ashraf Imam4,6
  • Matan Joel Cohen4,7
  • Maya Korem3,4
7 affiliations
  1. 1Institute for Research in Military Medicine, Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
  2. 2The Israel Defense Forces Medical Corps, Jerusalem 5262000, Israel.
  3. 3Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel.
  4. 4Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel.
  5. 5Department of Medical Intensive Care, Hadassah Medical Center, Jerusalem 91120, Israel.
  6. 6Transplantation Unit, Hadassah Medical Center, Jerusalem 91120, Israel.
  7. 7Clalit Health Services, Jerusalem District, P.O. Box 27670, Jerusalem 9127601, Israel.
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Abstract

Objectives

Infectious complications, particularly those caused by multidrug-resistant organisms (MDROs), remain a major cause of morbidity and mortality after liver transplantation (LT). While pre-transplant colonization is a recognized risk factor, its prognostic significance relative to post-transplant MDRO status remains unclear. This study evaluated the clinical impact of MDRO presence across the transplant timeline and identified predictors of post-transplant mortality and graft dysfunction.Methods

A retrospective cohort study of 110 adult LT recipients (2018-2024) was conducted at a tertiary center. Patients were stratified by pre-transplant ESBL/MDRO colonization or infection and by post-transplant MDRO status (modeled as a time-dependent exposure). Primary outcomes were one-year all-cause mortality and adverse graft outcomes.Results

Pre-transplant ESBL/MDRO presence (40% of recipients) was not associated with increased one-year mortality or adverse graft outcomes. Conversely, post-transplant MDRO status occurred in 44.5% of patients and was strongly associated with poor outcomes. Post-transplant MDRO colonization or infection was present in 88% (14/16) of non-survivors vs. 37% (35/94) of survivors (p < 0.001). One-year mortality was 47% (9/19) for post-transplant MDRO infection, 17% (5/30) for colonization alone, and 3% (2/61) with no post-transplant MDRO event. In a penalized time-dependent Cox model, post-transplant MDRO acquisition was independently associated with one-year mortality (HR 4.0, 95% CI 1.77-9.03; p < 0.001), confirmed by landmark analysis (HR 3.15, 95% CI 1.08-9.19), whereas pre-transplant status showed no association (p = 0.18).Conclusions

While pre-transplant status did not significantly impact one-year mortality in this cohort, post-transplant MDRO acquisition was independently associated with one-year mortality. Pre-transplant status should guide targeted prophylaxis, whereas the post-transplant period represents the critical window for infection prevention and antimicrobial stewardship interventions.

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Cite

BibTeXRIS
BibTeX
@article{aliev2026impact,
  title = {{The Impact of Pre- Versus Post-Transplant Multidrug-Resistant Organism Colonization on Liver Transplant Outcomes: A Retrospective Cohort Study.}},
  author = {Emil Aliev and Efrat Orenbuch-Harroch and Abed Khalaileh and Ashraf Imam and Matan Joel Cohen and Maya Korem},
  journal = {Diseases (Basel, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3390/diseases14100362},
  url = {https://europepmc.org/article/MED/42929989},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The Impact of Pre- Versus Post-Transplant Multidrug-Resistant Organism Colonization on Liver Transplant Outcomes: A Retrospective Cohort Study.
AU  - Emil Aliev
AU  - Efrat Orenbuch-Harroch
AU  - Abed Khalaileh
AU  - Ashraf Imam
AU  - Matan Joel Cohen
AU  - Maya Korem
PY  - 2026
DA  - 2026/10/01
JO  - Diseases (Basel, Switzerland)
DO  - 10.3390/diseases14100362
UR  - https://europepmc.org/article/MED/42929989
AB  - Objectives  Infectious complications, particularly those caused by multidrug-resistant organisms (MDROs), remain a major cause of morbidity and mortality after liver transplantation (LT). While pre-transplant colonization is a recognized risk factor, its prognostic significance relative to post-transplant MDRO status remains unclear. This study evaluated the clinical impact of MDRO presence across the transplant timeline and identified predictors of post-transplant mortality and graft dysfunction.Methods  A retrospective cohort study of 110 adult LT recipients (2018-2024) was conducted at a tertiary center. Patients were stratified by pre-transplant ESBL/MDRO colonization or infection and by post-transplant MDRO status (modeled as a time-dependent exposure). Primary outcomes were one-year all-cause mortality and adverse graft outcomes.Results  Pre-transplant ESBL/MDRO presence (40% of recipients) was not associated with increased one-year mortality or adverse graft outcomes. Conversely, post-transplant MDRO status occurred in 44.5% of patients and was strongly associated with poor outcomes. Post-transplant MDRO colonization or infection was present in 88% (14/16) of non-survivors vs. 37% (35/94) of survivors (p < 0.001). One-year mortality was 47% (9/19) for post-transplant MDRO infection, 17% (5/30) for colonization alone, and 3% (2/61) with no post-transplant MDRO event. In a penalized time-dependent Cox model, post-transplant MDRO acquisition was independently associated with one-year mortality (HR 4.0, 95% CI 1.77-9.03; p < 0.001), confirmed by landmark analysis (HR 3.15, 95% CI 1.08-9.19), whereas pre-transplant status showed no association (p = 0.18).Conclusions  While pre-transplant status did not significantly impact one-year mortality in this cohort, post-transplant MDRO acquisition was independently associated with one-year mortality. Pre-transplant status should guide targeted prophylaxis, whereas the post-transplant period represents the critical window for infection prevention and antimicrobial stewardship interventions.
SN  - 2079-9721
ER  -