Infections Associated to Intestinal and Multivisceral Transplantation: an Eight Year Experience at a Single Center

ELIZABETH MADSEN; CLAUDIA CONDORI ; HECTOR SOLAR; GABRIEL E. GONDOLESI ; SERGIO MARTINI NOVAS; ANALIA FERNANDEZ; PATRICIA ANDRES; ANA CABANNE; CLAUDIA NAGEL

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

Introduction: Although multiple advances in the last decade contributedto improved survival in intestinal/multivisceral (I/MTV) transplantation,infections (inf) still cause significant morbidity andmortality. Our aim is to analyze infectious episodes (ie) in the adultI/MTV transplants performed at our center.Patients and Methods: Retrospective review of 14 adult I/MTVtransplants performed between 5/2006 and 12/2014. 12 patients (pt)that survived > 72 hs were included: 10 isolate I, 1 MTV and 1 modifiedMTV.Inmunosupressive regime was as induction: basiliximab or ALG;manteinance: FK+antiproliferative agent+steroids.All pt received prophylaxis: perioperative antibiotics 5 days (ds); antifungal1 month; for PCP 1 year (y); for CMV 3-6 months and preemptivetreatment for EBV 1 y.Statistical analysis was done using SPSS v.17ÒResults:- Mean Age: 33.3 ± 13. ♂ 11 and ♀ 1.- Re-operations for non infectious causes were necessary in 4/12(30%) pt.- Mean time of post transplant (ptx) permanence of parenteral nutritioncatheter: 45 ds ± 49.3- 11/12 pt (91.7%) had 44 ie; 1 ie: in 27.3%; ≥ 2 and ≤ 4 ie: in 27.3%and > 4 ie: in 45.5% pt. 70.4% (31/44) were bacterial inf; meantime from the transplant to the ie (mtft/ie) was: 667.7 ds ± 905.4;viral: 20.4% (9/44); mtft/ie was: 615.1 ds ± 619.1; mycotic: 11.4%(5/44); mtft/ie was: 496.1 ds ± 788.5; and 1 parasitic.- 74.2% of bacterial ie took place > 60 ds ptx. This was related to:prolonged postoperative hospital (h) stay (45.2%), need of frequenth readmissions for non inf causes (32.2%) and late communityacquired inf (22.6%). Sites of inf were: bloodstream: 13(41.9%); intraabdominal: 6 (19.4%); lung: 5 (16.1 %); urinary tract:3 (9.7%); wound inf: 1 (3.2%); other: 3 (9.7%).- Bacteria isolated: 26 (61.9%) gram negative rods and 16 (38.1%)gram positive bacteria. 21 (50%) were multidrug resistantpathogens (mdrp) including carbapenem resistant Klebsiellapneumoniae which was isolated from multiple sites in 2 pt causingtheir death. These ie were preceded by pre or ptx prolonged hstay, antibiotic treatments, known colonization or need of reoperations.- Fungal ie documented: 5/4 pt: 4 Candida spp, 1 Criptococcus neoformans.- Viral ie documented: 9/7 pt and were due to: CMV: 4; Parainfluenza:1;Influenza A: 1; HPV: 1; HHV8: 1; Rotavirus: 1; with allograftenteritis in 5 of them.- The only parasitic ie was due to Isospora belli.- 9/12 pt had 31 episodes of acute cellular rejection (eACR); 2.6episodes/pt; being 29.5% of ie preceded by eACR.- Mean time of follow up: 1227.7 ds. In 4/8 pt (50%) inf was the attributablecause of death.- Graft and pt survival was at: 1 y 83%; 3 y 66%; 5 y 53%.Conclusions:- Like others, we observed that the classic timeline of ie for solid organsdid not apply for I/MTV transplants.- Infections had a profound negative impact in pt outcome.- In these adult population viral enteritis did not cause graft nor ptloss.References:1. Infect Dis Clin N Am 2013; 27: 359-3772. Transpl Infect Dis 2013; 15: 441-4483. Transpl Infect Dis 2012; 14: 242-2474. Transpl Infect Dis 2010; 12(1):69-725. Transplantation 2010; 90 (5):547-5546. Transplantation 2005; 80 (12): 1742-1747