title: Infectious Complications Following Small Bowel Transplantation.
abstract: Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a retrospective analysis of all patients undergoing SBT from 2004 to 2013 in Spain. Sixty-nine patients underwent a total of 87 SBT procedures (65 pediatric, 22 adult). The median follow-up was 867 days. Overall, 81 transplant patients (93.1%) developed 263 episodes of infection (incidence rate: 2.81 episodes per 1000 transplant-days), with no significant differences between adult and pediatric populations. Most infections were bacterial (47.5%). Despite universal prophylaxis, 22 transplant patients (25.3%) developed cytomegalovirus disease, mainly in the form of enteritis. Specifically, 54 episodes of opportunistic infection (OI) occurred in 35 transplant patients. Infection was the major cause of mortality (17 of 24 deaths). Multivariate analysis identified retransplantation (hazard ratio [HR]: 2.21; 95% confidence interval [CI]: 1.02-4.80; p = 0.046) and posttransplant renal replacement therapy (RRT; HR: 4.19; 95% CI: 1.40-12.60; p = 0.011) as risk factors for OI. RRT was also a risk factor for invasive fungal disease (IFD; HR: 24.90; 95% CI: 5.35-115.91; p < 0.001). In conclusion, infection is the most frequent complication and the leading cause of death following SBT. Posttransplant RRT and retransplantation identify those recipients at high risk for developing OI and IFD.
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: J T
authors.initials: JT
authors.lastname: Silva
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: San-Juan
authors.affiliation: Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Fernández-Caamaño
authors.affiliation: Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Prieto-Bozano
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Lumbreras
authors.affiliation: Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital "12 de Octubre," Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Calvo-Pulido
authors.affiliation: Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital "12 de Octubre," Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Jiménez-Romero
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Resino-Foz
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: López-Medrano
authors.affiliation: Department of Pediatric Surgery, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lopez-Santamaria
authors.affiliation: Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Maria Aguado
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000382:microbiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D009181:Mycoses / Q000453:epidemiology / Q000382:microbiology*; D009894:Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: (allograft) function; clinical research; dysfunction; infectious; infectious disease; intestinal; intestinal disease; intestine; malignant; multivisceral transplantation; practice