Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2016; 8(36): 1617-1622
Published online Dec 28, 2016. doi: 10.4254/wjh.v8.i36.1617
Spontaneous bacterial peritonitis prevalence in pre-transplant patients and its effect on survival and graft loss post-transplant
Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup
Neeral L Shah, Nicolas M Intagliata, Zachary H Henry, Curtis K Argo, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, United States
Author contributions: Shah NL and Northup PG and performed designed research; Northup PG analyzed data; Shah NL, Intagliata NM, Henry ZH, Argo CK and Northup PG wrote the paper.
Institutional review board statement: Study approved by IRB at University of Virginia.
Informed consent statement: A cohort study on a de-identified population did not require consent.
Conflict-of-interest statement: We have no conflicts of interest to report.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Neeral L Shah, MD, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Jefferson Park Avenue, PO Box 800708, Charlottesville, VA 22908, United States.
Telephone: +1-434-9242626 Fax: +1-434-2447586
Received: June 28, 2016
Peer-review started: June 30, 2016
First decision: August 5, 2016
Revised: October 25, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: December 28, 2016

To investigate the incidence of spontaneous bacterial peritonitis (SBP) in pre-transplant patients and its effect on post transplant mortality and graft failure.


We conducted a retrospective cohort study of patient records from the organ procurement and transplant network data set. Patients were identified by the presence of SBP pre-transplant. Univariate post-transplant survival models were constructed using the Kaplan-Meier technique and multivariate models were constructed using the Cox proportional hazards model. Variables that affected post-transplant graft survival were identified in the SBP population.


Forty-seven thousand eight hundred and eighty patient records were included in the analysis for both groups, and 1966 (4.11%) patients were identified in the data set as having pre-transplant SBP. Patients that had pre-transplant SBP had higher rates of graft loss from recurrent hepatitis C virus (HCV) (3.6% vs 2.0%, P < 0.0001), infections leading to graft loss (1.9% vs 1.3%, P = 0.02), primary non-function (4.3% vs 3.0%, P < 0.0001) and chronic rejection (1.1% vs 0.7%, P = 0.04). Kaplan-Meier survival analysis showed a statistically significant difference in all-cause survival in patients with a history of SBP vs those without (P < 0.0001). Pre-transplant history of SBP was independently predictive of mortality due to recurrent HCV (HR = 1.11, 95%CI: 1.02-1.21, P < 0.017) after liver transplantation.


HCV patients prior to the advent of directing acting anti-viral agents had a higher incidence of pre-transplant SBP than other patients on the liver transplant wait list. SBP history pre-transplant resulted in a higher rate of graft loss due to recurrent HCV infection and chronic rejection.

Keywords: Spontaneous bacterial peritonitis, Liver transplant, Graft failure, Hepatitis C

Core tip: Prevention of spontaneous bacterial peritonitis (SBP) pre-transplant may affect graft outcomes and ultimately patient survival post-transplant. Patients with hepatitis C virus (HCV) in whom therapy is deferred until the time of transplant due to hepatic decompensation, may benefit from expedited treatment if they possess a history of SBP to avoid complications related to HCV recurrence.