Prevalence and outcome of Ventilator-associated pneumonia (VAP) in living donor liver transplant (LDLT) patients in a developing country

Abstract

Background and Objectives: Patients using mechanical ventilation for more than 48 hours may develop ventilator-associated pneumonia (VAP). There is limited data on the prevalence of VAP following liver transplantation from developing countries, especially in living donor liver transplant (LDLT) patients. Our study’s goals were to ascertain the prevalence, risk factors, and outcomes of VAP in patients who have undergone LDLT.

Methodology: This retrospective study reviewed 324 patients who underwent LDLT at the Pakistan Kidney and Liver Institute and Research Centre (PKLI-RC) between January 1st, 2022 to December 31st, 2023. VAP was identified based on microbiological and clinical criteria. Clinical characteristics, demographics, and mortality outcomes were recorded.

Results: Among 324 liver transplant patients, 253 (78.1%) were male and 71 (21.9%) were female. Hepatitis C virus (HCV; 58.95%) was the most common cause of end-stage liver disease (ESLD) requiring transplantation. Seven patients (2.2%) developed VAP, of which four did not survive (57.1%), suggesting higher mortality (p-value < 0.001) from VAP. A pre-operative Child-Turcotte-Pugh (CTP) score >13 was associated with higher post-operative mortality (p-value 0.041). The presence of VAP significantly increased intensive care units (ICU) length of stay (p-value 0.018) and mortality (p-value 0.001).

Conclusion: This study showed a low prevalence of VAP in LDLT patients; however, they stayed in the ICU for longer periods and had higher mortality. Considering the complexity and cost of liver transplantation and ICU care, adherence to VAP bundles and purpose-built facilities would prevent VAP and minimize the cost specifically in countries with limited resources.