C. difficile among LT recipients is associated with decreased overall survival after transplantation

PHILADELPHIA — Liver transplant recipients who developed Clostridium difficile after transplantation had a lower overall survival rate compared to those who did not develop the infection, according to data presented at IDWeek 2014.

Timothy Sullivan, MD, of Mount Sinai Hospital, and colleagues reviewed antibiotic exposures of 192 LT recipients from Mount Sinai Hospital between January 2011 and April 2013 to determine risk factors for Clostridium difficile among this patient population, as well as how commonly it develops after transplantation. Exposures analyzed were from 1 year prior to transplantation through 1 year after transplantation.

Timothy Sullivan

Twenty-seven patients developed Clostridium difficile and 56% of those developed it within 2 weeks of transplantation. The patients who developed Clostridium difficile were more likely to have higher model for end-stage liver disease (MELD) scores (mean 24.4 vs. 19.8; P=.04), nonalcoholic steatohepatitis (NASH)-based liver disease (five of 27 vs. nine of 165, P=.031) or HIV/HCV coinfection (three of 27 vs. two of 165, P=.021) compared to those without C. diff.

One year after transplantation, patients with Clostridium difficile were admitted to the hospital more often (2.7 vs. 1.3 admissions; P=.0006), spent more time in the hospital (34.1 vs. 10.7 days; P=.0001) and had more instances of receiving high-risk antibiotics (18.3 vs. 9.6; P=.041).

All Clostridium difficile patients were treated with metronidazole or oral vancomycin for an average of 14.9 days. All were successfully treated, however, six patients relapsed. No patients died of Clostridium difficile after an average follow-up of 1.8 years, but overall survival was lower among the patients with Clostridium difficile (78%) compared with those without it (92%, P=.033).

“What we found by looking at the risk factors for C. diff infection in liver transplant recipients was that on the univariate analysis, having a higher MELD score and also having underlying liver disease due to either NASH cirrhosis or HCV/HIV coinfection are associated with higher risk of C. diff,” Sullivan told Healio.com/Hepatology. “On the multivariate analysis, receiving a transplant from a living donor, having hepatocellular carcinoma and also having a higher MELD score were determined to be significant predictors of C. diff. We also found that a large majority of the cases occurred in the first 2 weeks after liver transplant and that C. diff was significantly associated with a higher rate of death following transplant.” — by Melinda Stevens

For more information:

Sullivan T. Abstract 448. Presented at: IDWeek 2014, Oct. 8-12; Philadelphia.

Disclosure: The researchers report no relevant financial disclosures.