Early and late onset Clostridium difficile-associated colitis following liver transplantation.
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.
Albright
Jeffrey B
JB
Department of Surgery, Mayo Clinic, Jacksonville, FL 32116, USA.
Bonatti
Hugo
H
Mendez
Julio
J
Kramer
David
D
Stauffer
John
J
Hinder
Ronald
R
Michel
Jaime A
JA
Dickson
Rolland C
RC
Hughes
Chris
C
Nguyen
Justin
J
Chua
Heidi
H
Hellinger
Walter
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016360:Clostridioides difficile / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D007166:Immunosuppressive Agents