Incidence of Surgical site infections (SSIs) in liver transplantation: A Systematic Review and Meta-analysis

Background: No previous systematic review study has been found that exclusively addresses the incidence of surgical site infection in liver transplant patients. This systematic review was conducted to determine the pooled incidence of postoperative SSI after liver transplantation.
Material and Methods: A systematic literature review was performed following PRISMA guidelines, using MEDLINE databases via MeSH terms, as well as PubMed, Web of Science, and Scopus without language or date restrictions. Two independent reviewers carried out data extraction. We included prospective or retrospective studies that have reported the incidence of SSIs. The Newcastle–Ottawa scale was used to evaluate the risk of bias in the studies. The pooled incidence was calculated using R software version 4.2.0.
Findings: Among the 722 publications assessed, 37 observational studies were included in the meta-analysis, involving 15589 adult and pediatric patients undergoing surgery. Using a random-effects model, the pooled incidence of SSI was 16.50(13.73;19.71). Organ/Space infection (10.61 [7.06;15.63]) was the most common type of infection, followed by superficial infection (2.60 [16.2;2.16]) and deep infection (1.94 [1.06;2.52]). A higher incidence was observed in pediatric patients at 23.21 (16.44; 31.71) compared to adult patients at 13.96(11.26;17.18).
Conclusion: Surgical site infections are frequent after liver transplantation worldwide, especially in pediatric patients. Organ/space infection is the predominant type of surgical site infection in liver transplantation. Though Organ/Space infection is mainly caused by intraoperative factors, risk factors during surgery should be further investigated in these patients.