Vera M. Rosado-Odom², Raymond Johnson², Rodrigo M. Vianna¹, A. Joseph Tector¹, Chekar Kubal¹, Richard S. Mangus¹

¹Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States; ²Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States

Introduction: The majority of intestinal transplant patients have a complex medical and surgical history, with a significant exposure to infections organisms. The primary cause of death post-transplant in these patients is infection-related sepsis. This study reviews the 1-year post-transplant infections in a cohort of adult and pediatric patients who underwent both isolated intestinal and multiorgan transplant.

Methods: This single center study is a retrospective medical record review of 121 intestinal transplants patients between 2004 and 2009 who underwent intestinal transplantation. All patients were followed for a minimum of 1-year and received all of their care at one center. Infections were categorized as bacterial, viral, and fungal with a review of both culture/serology studies, as well as clinical interventions such as antibiotics, surgery or drainage. Individual infectious events required previous clearance of an organism before being counted as a new event. All patients received rabbit anti-thymocyte globulin induction immunosuppression with tacrolimus based maintenance immunosuppression. Statistical analysis utilized stratification by age group (adult/pediatric) and organ group (intestine alone/multivisceral (MVT)).

Results: There were 91 adults and 30 pediatric patients. The stratified 1-year infectious risks are listed in the table.

Conclusions: In the first year post-intestinal transplant, all patient and organ groups carried a 90-100% risk of bacterial infection, a 15-30% risk of CMV infection, and a 30-50% risk of fungal infection. Compared to the adult MVT group, the adult intestine alone group had a greater number of blood stream infections (median 3.2 versus 1.7, p=0.01) and fungal infections (median 1.0 versus 0.4, p=0.01). The pediatric MVT and intestine alone groups did not differ significantly in their risks for bacterial, viral and fungal infections. Of note, for both adult and pediatric populations, the intestine alone group was at a much higher risk of rejection.