*Purpose: Perioperative antibiotic use has important implications for patient care, antimicrobial stewardship, and cost containment. There is limited data guiding the optimal duration of perioperative antimicrobial prophylaxis to prevent surgical site infection (SSI) following liver transplant (LT).

*Methods: We conducted a single-center, retrospective review of adult LT recipients (LTRs) from 9/2016 to 10/2018. LTRs received surgical prophylaxis with ampicillin-sulbactam or vancomycin plus levofloxacin (if penicillin-allergic). SSI incidence was compared between LTRs receiving extended prophylaxis (defined as any postoperative doses) vs intraoperative prophylaxis only.

*Results: The preliminary cohort included 100 LTRs (50 per group). Baseline characteristics were similar: overall mean (SD) age was 59±9.3 years, 63% were male, 91% were white, and mean (SD) UNOS MELD at LT was 26.7±6. Nine LTRs (18%) per group were transplanted during a hospital admission. Duration of surgery, units of intraoperative PRBCs administered, and number of LTRs receiving fluconazole for invasive fungal prophylaxis were similar (p≥0.117). Post-LT, 10% of LTRs receiving extended prophylaxis vs 8% receiving intraoperative prophylaxis required reoperation. Additional antibiotic use for any reason within 30-days post-LT was comparable between LTRs receiving extended vs intraoperative prophylaxis (22% vs 32%, p=0.368). In LTRs who received antibiotics for confirmed/suspected infection, immunosuppression regimens were similar in those receiving extended vs intraoperative prophylaxis with mean (SD) tacrolimus levels of 9±5.3 ng/mL and 10.4±3.6 ng/mL at antibiotic initiation, respectively. Infection data for the intention-to-treat (ITT) and per protocol (PP) populations are shown in Table 1 (p>0.05 for all comparisons).

*Conclusions: In a real-world LT population, intraoperative antimicrobial prophylaxis may be sufficient to prevent SSI. By reducing prophylactic antibiotic exposure and treatment duration at the time of LT, use of intraoperative prophylaxis alone may help improve antimicrobial stewardship. Larger studies are needed to confirm the optimal duration of surgical prophylaxis in LT. Antibiotic use beyond the perioperative period should be treatment directed.

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