P16. Post-surgical infections in liver transplantation performed using robotic surgery: preliminary results of a case-control study

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Abstract Background Minimally invasive robotic surgery is a safe and effective approach for the resection of primary and metastatic liver tumors, as well as for living donor liver transplantation. However, only a limited number of centers worldwide have adopted robotic surgery for deceased donor liver transplantation. No data are available on the incidence of postoperative infections in this population. Methods Retrospective, observational, case-control study (1:2) in which patients who underwent minimally invasive robotic liver transplantation (RLT) from deceased donors between January and September 2024 at AOU of Modena were included. Control population was selected from patients who received deceased donor liver transplantation via laparotomy, matched for age, transplant indication, and transplantation period. Aim of the study was to compare postoperative infections and complications within the first 90 days post-transplant and median length of hospital stay between the two groups. Results A total of 21 patients were enrolled (7 RLT and 14 OLT). Patient characteristics are shown in Table 1. One patient per group developed CMV symptomatic infection respectively 65 and 42 post-operative days (POD) after transplantation, both treated with valganciclovir and immunosuppression reduction. Another patient in the RLT group developed oral candidiasis in POD 9, treated with oral fluconazole. In the OLT group three patients developed infections: one C.parapsilosis and E.faecium blood stream infection (BSI) in POD 1 treated with linezolid and anidulafungin, one S.sanguinis BSI in POD 1 and one K. pneumoniae ESBL urinary tract infection in POD 1 treated with ertapenem. In the OLT group, one patient underwent reoperation for biliodigestive anastomosis revision in POD 3. In the RLT group, a significant reduction in the median length of hospital stay was observed (5 versus 9 days, P = 0.001). All patients are alive and no case of graft failure occurred. Conclusions In our small sample, three post-operative bacterial infections developed in the OLT group within the first 90 days after transplantation and no infection in RLT group, despite the presence of patients colonized by MDR pathogens. The RLT group showed a significant reduction in the median length of hospital stay post-transplant.Table 1.Patient's characteristics and indication at transplant RLT (n = 7)OLT (n = 14)p valueAge (years), median (IQR)65 (59–71)64 (56–73)0.709Principal indication for transplant, n (%)HCCAlcoholic liver cirrhosis6 (86)1 (14)11 (79)3 (21)0.694Second indication, n (%)ASH e/o NASHHCV e/o HBV4 (57)5 (71)9 (64)6 (43)0.5890.279MELD Na, median (IQR)8 (6–26)11 (8–20)0.132Child-Pugh, median (IQR)5 (5–12)7 (5–9)0.814Charlson Comorbidity Index, median (IQR)5 (4–7)6 (4–10)0.193BMI (Kg/m2), median (IQR)26.3 (20.1–29.4)26.0 (17.0–42.0)1.000ESBL rectal colonization at transplant, n (%)2 (29)2 (14)0.720VRE rectal colonization at transplant, n (%)2 (29)1 (7)0.830ICU stay (days), median (IQR)1 (1–3)1 (0–4)0.805LOS after transplantation (days), median (IQR)5 (4–7)9 (6–21)0.001Total follow-up period, median (IQR)141 (79–174)180 (109–264)ASH, Alcoholic Steatohepatitis; BMI, Body Mass Index; ESBL, Extended Spectrum Beta-Lactamase; HBV, Hepatitis B Virus; HCC, Hepato Cellular Carcinoma; HCV, Hepatitis C Virus; IQR, Interquartile Range; LOS, Length Of Stay; MELD, Model for End-Stage Liver Disease; NASH, Non-Alcoholic Steatohepatitis; OLT, Orthotopic Liver Transplantation; RLT, Robotic Liver Transplantation; VRE, Vancomycin Resistant Enterococcus.

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