Safety and Efficacy of Early Central Line Removal in Post Liver Transplant Patients

Author(s):

Elizabeth MacLean; Tayseer Shamaa; Omar Shamaa; Zoe Lu; Amita Hinge; Sara Saymuah; Adhnan Mohamed; Toshihiro Kitajima; Michael Rizzari; Shunji Nagai; Atsushi Yoshida; Marwan Abouljoud; Kelly Collins

Background:

Avoiding central line-associated infections (CLABSIs) is paramount in liver transplant recipients. As a hospital-wide infection control initiative at our institution, early removal of central lines after liver transplant (LT) was instituted beginning in September 2019. The aim of the study was to compare the outcomes of patients before and after this change in practice.

Hypothesis:

Our hypothesis is that the rate of CLABSIs in the post-operative period dropped after the implementation of the policy at our institution.

Methods:

Retrospective analysis using the databases from a single transplant center and UNOS. 470 adult patients who underwent liver-alone transplants at our center between January 2017 and June 2021 were included.  LTs performed during September 2019 were excluded as a washout period. Demographics, clinical characteristics, and post-transplant outcomes were compared between the pre-and post-policy implementation groups.

Results:

447 patients were included in the analysis with 274 (61.3%) patients transplanted prior to the practice change and 173 (38.7%) patients after. Age, gender, race, BMI, MELD, and etiology of end-stage liver disease (ESLD) did not differ between the two groups. The median duration of central line placement in the pre-policy period was 156 hours (Interquartile Range [IQR]: 71-224 hours) compared to 43.5 hours (IQR: 28.4-60.3 hours) in the post-policy period (p<0.001). 5.9% of pre-policy patients had a central line reinserted during their initial post-LT hospitalization compared to 0.6% of post-policy patients (p=0.005). There was a significant increase in the utilization of peripheral inserted central catheter (PICCs) in the post-policy period compared to the pre-policy period (12.8% vs. 7.1%; p=0.045). There was no difference in the rate of CLABSI amongst the two groups with 1.1% (n=3) of pre-policy patients having a CLABSI compared to 2.3% (n=4) of post-policy patients (p=0.31).

Conclusions:

The early removal of central lines after LT is safe, efficacious, and should be considered in patients without the need for central access. Although CLABSI rates were similar, the shorter central line use was not associated with increased reinsertion of central lines or PICC-associated venous thromboembolism.