Early and late onset Clostridium difficile-associated colitis following liver transplantation

Abstract

Summary Clostridium difficile colitis (CDC) remains a serious and common complication after liver transplantation (LT). Four hundred and sixty‐seven consecutive LTs in 402 individuals were performed between 1998 and 2001 at our center. Standard immunosuppression consisted of tacrolimus, mycophenolate, and steroids. CD toxins A and B were detected by using a rapid immunoassay or enzyme immunoassay. CDC was diagnosed in 32 patients (5–1999 days post‐LT), with 93.8% (30/32) of patients developing CDC during the first year post‐LT; three individuals had CDC more than 3 years post‐LT, one of which also had early CDC. All patients presented with abdominal pain and watery diarrhea. Patients who developed CDC within 1‐year post‐LT were significantly more likely to have a hemorrhagic, biliary, or infectious complication. Patients who developed CDC within 28 days post‐LT had a significantly higher model end‐stage liver disease score. Treatment consisted of fluid and electrolyte replacement and metronidazole and no patients developed toxic megacolon, required colonic resection, or died from CDC. CDC represents a potentially severe complication following LT. Most cases occur early post‐LT. Development of a hemorrhagic, biliary, or infectious complication is associated with the development of CDC.

Clostridium difficile Infection in Liver Transplant Recipients: A Retrospective Study of Rates, Risk Factors and Outcomes

“…Although the exact incidence of diarrhea in LTR is unknown, incidence rates of 10-43% have been reported in other solid organ transplant populations (1). Diarrhea attributable to Clostridium difficile infection (CDI) is reported to occur in 3.5-9% of LTR (2)(3)(4). A significant increase in the incidence and severity of CDI has been reported in recent years, in part believed to be due to the emergence of a new hypervirulent and easily transmissible strain called the North American Pulsed-Field Type 1 strain (NAP-1) of C. difficile (5).…”

Fidaxomicin versus Conventional Antimicrobial Therapy in 59 Recipients of Solid Organ and Hematopoietic Stem Cell Transplantation with Clostridium difficile-Associated Diarrhea

“…Continued use of systemic broad-spectrum antibiotics during CDAD treatment is a well-recognized risk for clinical treatment failure and disease recurrence (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In the 59 transplant recipients presented, the prevalence of exposure to systemic antibiotics was high and significantly associated with a lack of clinical treatment response (Tables 1 and 2).…”

“…Clostridium difficile-associated diarrhea (CDAD), and the response to conventional anti-CDAD therapy with oral vancomycin or metronidazole remains suboptimal (1)(2)(3)(4)(5)(6). Fidaxomicin, a macrocyclic antibiotic with a limited spectrum of antimicrobial activity, became available in the United States in May 2011 (6)(7)(8)(9).…”

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

“…The incidence of CDI in transplant patients has been estimated at 3%-7% for liver recipients, 3.5%-16% for kidney recipients, 1.5%-7.8% in pancreas-kidney recipients, 9% in intestinal recipients, 15% in heart recipients, and 7%-31% in lung recipients [16] . Further fulminant colitis is noted to occur in up to 8% of immunocompromised patients and 13% of solid organ transplant recipients with the highest incidence within the first 3 mo [17,18] . The treatment of CDI in immunosuppressed patients should follow the same guidelines based on disease severity as those outlined in this paper.…”