Systematic review and meta-analysis of modifiable risk factors affecting organ-space surgical site infections and their impact on long-term transplant outcomes following liver transplantation

Abstract

Liver transplantation is one of the most successful achievements in modern surgery, but surgical site infections, particularly organ-space infections, remain a major challenge. These infections include intra-abdominal abscesses, biliary infections, and peritonitis, and can have lasting negative effects on long-term transplant outcomes. This study aimed to identify modifiable risk factors associated with organ-space infections and examine their impact on long-term outcomes following liver transplantation. A systematic search was conducted in five databases: PubMed, Scopus, Web of Science, Cochrane Library, and Embase from 2020 to 2026. Inclusion criteria comprised cohort, case-control, and clinical trial studies reporting at least one modifiable risk factor. Of 750 identified articles, we included 7 studies with 4,840 patients in the final analysis. Results showed that colonization with carbapenem-resistant bacteria was the strongest risk factor, with an odds ratio of 3.85. Post-transplant dialysis requirement (OR=3.42), prolonged mechanical ventilation (OR=2.94), abdominal reoperation (OR=2.76), and biliary complications (OR=2.45) were other important factors. Inadequate glycemic control and elevated body mass index were also associated with increased risk of infection. Organ-space infections increased the risk of graft loss by 2.97-fold and patient mortality by 3.25-fold. Targeted management of these factors through microbiological screening, personalized antibiotic prophylaxis, and optimization of perioperative care can significantly improve liver transplant outcomes.