Infectious Complications Following Small Bowel Transplantation

Silva, J. T.; Juan, Rafael San; Fernández-Caamaño, Beatriz; Prieto-Bozano, G.; Fernández‐Ruiz, Mario; Lumbreras, Carlos; Pulido, Jorge Calvo; Jiménez-Romero, Carlos; Resino-Foz, Elena; López‐Medrano, Francisco; López‐Santamaría, Manuel; Aguado, José María

doi:10.1111/ajt.13535

Cited by 46 publications

(43 citation statements)

References 32 publications

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“…Bacterial infections frequently occur early in the post-transplant period, and in ITx they may be surgical mesh-related infections associated with problems of abdominal wall closure. CMV represents a nightmare in solid organ transplantation medicine, and intestinal involvement is not always associated with viremia; CMV enteritis may occur in up to 25% of recipients despite prophylaxis [36] . Patients undergoing ITx also show increased susceptibility to viral infection by norovirus or Epstein-Barr virus; in particular, adenovirus can be involved in AR.…”

Section: Intestinal Transplantationmentioning

confidence: 99%

Crohn's Disease and Intestinal Transplantation

Drastich

Oliverius

2017

Dig Dis

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Background: Most patients with Crohn's disease (CD) require one or more operations during their lifetime. Repeated resections and surgical complications may result in short gut in a subset of patients, typically those with extensive small bowel disease or a penetrating CD phenotype. The effects of short bowel syndrome (SBS) can range in seriousness from mild to life-threatening advanced intestinal failure. Worldwide, CD is the second leading indication for intestinal transplantation (ITx) in SBS, but the overall incidence of ITx is quite low. Key Messages: Currently, total parenteral nutrition (TPN) is the preferred treatment option for patients with SBS because of its superior survival outcome. However, TPN can fail from loss of venous access due to catheter-associated thromboses, recurrent catheter-related blood stream infections, or intestinal-failure-associated liver dysfunction. Three types of transplantations are available for CD patients - small bowel alone, liver plus small bowel and multivisceral, which includes other intra-abdominal organs. An abdominal wall transplant is required in case of abdominal wall defects or lack of free intra-abdominal space. The current 5-year survival rate of 54% following ITx of the isolated small bowel appears worse than that associated with TPN. However, outcomes are substantially improving because of surgical and technical advances and progress in medical therapy. On the other hand, ITx carries the risk of both complications (e.g., rejection, infections, and post transplant lymphoproliferative disorders) and adverse events associated with immunosuppression. CD recurrence has been reported in a few patients, but this primarily histologic recurrence might not be of great clinical importance. Conclusions: ITx has become a well-established treatment for those who fail on TPN and who have life-threatening complications. Fortunately, it concerns only a small proportion of CD patients, but it does offer reasonable survival and quality of life. Primary management of patients with small bowel failure should be provided by a center experienced in medical intestinal rehabilitation, nutrition, and transplantation of other solid organs.

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Section: Intestinal Transplantationmentioning

confidence: 99%

Crohn's Disease and Intestinal Transplantation

Drastich

Oliverius

2017

Dig Dis

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“…Of the nonopportunistic infections, 121 (60%) were bacterial (57%: Gram‐negative, 31%: Gram‐positive, and 12%: others). Bloodstream infection was seen in 72 (34%) of the cases .…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of intestinal transplant recipients colonized with multidrug-resistant organisms: a retrospective study

et al. 2017

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Rates of multidrug-resistant organisms (MDRO) colonization among intestinal transplant (ITx) recipients have not been reported. Colonization rates with vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Gram-negative bacteria (CR-GNB), and methicillin-resistant Staphylococcus aureus (MRSA) were obtained retrospectively in adults undergoing ITx (isolated or multivisceral) from 1/2009 to 12/2015. We assessed for VRE, CR-GNB, and MRSA bacteremia during the first year post-transplant for patients colonized with VRE, CR-GNB, and MRSA, respectively, and for those who were not colonized. We evaluated whether the number of hospitalization days and one year post-transplant survival were different in MDRO-colonized patients. Forty-five ITx recipients were identified. Twenty-eight (62%) were colonized with MDRO [VRE in 22 (50%) patients, MRSA in seven (16%), and CR-GNB in six (15%)]. VRE and CR-GNB-colonized patients were more likely to develop VRE and CR-GNB bacteremia, respectively, than noncolonized patients [8/22 (36%) vs. 1/23 (4%), and 4/6 (67%) vs. 2/39 (5%), P < 0.05 for both]. There was no difference in one-year survival between MDRO-colonized and noncolonized patients. However, survival was lower among MDRO-colonized patients who developed VRE, CR-GNB, or MRSA bacteremia (P < 0.001). MDRO colonization was common among our ITx recipients. VRE and CR-GNB bacteremia was more common among colonized patients, and survival was lower among MDRO-colonized patients who developed bacteremia.

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“…5 However, it was not examined in prior studies. [2][3][4] Our study was designed to evaluate the number of BSI episodes due to enteric organisms and its sources including gut translocation during the first 6 months post transplant among adult ITx recipients at our center. There were no differences in the surgical technique between surgical teams.…”

Section: Introductionmentioning

confidence: 99%

Bloodstream infection caused by enteric organisms during the first 6 months after intestinal transplant

Simkins

Morillas‐Rodriguez

Morris

et al. 2019

Transplant Infectious Dis

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Background Data on bloodstream infection (BSI) due to enteric organisms are scarce. Methods This retrospective study (1/2009‐5/2017) was aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first 6 months after intestinal transplant (ITx). Differences between the first (2009‐2012) and second period (2013‐2017) were evaluated as they differed from each other in the perioperative fungal prophylaxis and immunosuppressive regimen. Results Fifty‐five adult patients were analyzed. Twenty‐eight (51%) patients developed a total of 51 episodes of BSI. Mean time from transplant to BSI was 85.5 ± 58.8 days. The most common organisms were Klebsiella pneumoniae (33%), Enterococcus spp (31%), and Candida spp (18%). Twenty‐three (45%) were multidrug resistant. The most common sources were gut translocation (35%), central line infection (20%), and intra‐abdominal abscess (14%). Biopsy‐proven rejection was associated with 16 (31%) of the BSI episodes. Patients during the first period were more likely to develop BSI (79% vs 41%, P = 0.03). There were more episodes of rejection associated with BSI in the first period (45% vs 14%, P = 0.03). The rate of reoperation into the abdominal cavity within 2 weeks after ITx was higher and the transplant hospital stay was longer among those who developed BSI (P = 0.04 for both). Conclusions Half of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.

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Infectious Complications Following Small Bowel Transplantation

Cited by 46 publications

References 32 publications

Crohn's Disease and Intestinal Transplantation

Crohn's Disease and Intestinal Transplantation

Clinical outcomes of intestinal transplant recipients colonized with multidrug-resistant organisms: a retrospective study

Bloodstream infection caused by enteric organisms during the first 6 months after intestinal transplant

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