J. W. Clouse1, C. A. Kubal1, B. Ekser1, J. A. Fridell1, R. S. Mangus1 1Indiana University School Of Medicine,Department Of Surgery, Transplant Division,Indianapolis, IN, USA
Introduction:
The risk for post-intestine transplant infection is greatest in the first year, primarily related to the need for high doses of immunosuppression when compared to other transplant organs. This study reports the infection rate, location of infection, and pathogen causing bacterial, fungal, or viral infections in intestine transplant recipients at an active transplant center. Additional risk for infection was assessed based on simultaneous inclusion of the liver or colon as a part of the intestine transplant.
Methods:
Records from a single transplant center were reviewed for adult (≥18 years old) patients receiving an intestine transplant. Positive cultures and pathology reports were used to diagnose bacterial, fungal, and viral infections and also to determine location and infectious agent.
Results:
During the study period 184 intestine transplants were performed on 168 adult patients. One-year bacterial, fungal, and viral infection rates were 91%, 47%, and 29%, respectively. The most commonly infected sites were the urinary tract and bloodstream. Coagulase-negative Staphylococcus was the most commonly isolated pathogen and found in 48% of patients. Antibiotic resistant strains were frequently observed with VRE infecting 45% of patients and MRSA infecting 15%. The majority of VRE cases occurred after 2008. Klebsiella and E. coli had the highest incidence of infection among gram-negative bacteria at 42% and 35%. Candida species were the most common fungal pathogens, and were seen in 42% of all patients, and in 89% of patients who developed a fungal infection. Candida glabrata was the most prominent Candida species and was present in over 75% of Candida-infected patients. Cytomegalovirus infections were present in 15% of transplant recipients, with 41% (6% overall) of those patients developing tissue-invasive disease. Bacterial and fungal bloodstream infections (BSI) developed in 72% of patients, with a median time to first infection of 30 days. Age, gender, race, liver inclusion, or colon inclusion did not have a significant impact on the development of a BSI or median time to first BSI.
Conclusion:
Overall, 91% of intestine transplant patients had a bacterial infection in the first year post transplant. Opportunistic fungal and viral infections were also very common. Inclusion of the colon with the small intestine significantly (p≤0.01) increases the risk for fungal bloodstream infections, and infections caused by C. difficile, Bacteroides species, Epstein-Barr virus and upper respiratory viruses (p<0.01 for each). In contrast, simultaneous transplant of the liver significantly (p=0.01) reduced the risk of developing a bacterial urinary tract infection.
