AbstractBackgroundPerfusion fluid (PRF) is employed in liver transplantation (LTx) to maintain graft viability. Still, it represents a new potential way of infection transmission in LTx recipients (LTRs). Currently, no systematic research has investigated this topic.MethodsFive‐year single‐center retrospective study conducted on LTRs from January 2017 to December 2021. We analyzed the incidence of positive PRF culture (PRF+) and perfusion fluid‐related infections (PRF‐RI) and their associated factors. We also assessed 1‐year mortality, both overall and infection‐related.ResultsOverall, 234 LTx were included. PRF+ were found in 31/234 (13.2%) LTx for a total of 37 isolates, with >1 isolate identified in 5 (2.1%) cases. High‐risk microorganisms (Enterobacterales 13/37, Enterococcus spp. 4/37, S. aureus 3/37, P. aeruginosa 2/37) were isolated in 25/37 (67.6%) LTRs, the remaining being coagulase‐negative staphylococci (12/37, 32.4%). Antimicrobial prophylaxis was administered to all LTRs, always active against the isolate even if suboptimal in 19 cases (61.3%). PRF‐RI developed in 4/234 LTx (1.7%), and prophylaxis was considered suboptimal in 2/4 of them. The isolation of >1 microorganism in PRF culture was associated with an increased risk of developing PRF‐RI (OR 37.5 [95%CI 2.6–548.4], p = .01). PRF‐RI were associated with longer ICU stays (p = .005) and higher 1‐year mortality, both overall and related to infections (p = .001).ConclusionDespite PRF+ being infrequent, only a minority of patients develops PRF‐RI. Nonetheless, once occurred, PRF‐RI seems to increase morbidity and mortality rates. image