2013 - ISBTS 2013 Symposium
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Posters and Exhibition
15.25 - Postoperative Infections Following Intestinal Transplantation
Presenter: Undine A., Gerlach, , Germany
Authors: Undine A. Gerlach1, Alexander Moll1, Peter Neuhaus1, Andreas Pascher1
Postoperative Infections Following Intestinal Transplantation
Undine A. Gerlach1, Alexander Moll1, Peter Neuhaus1, Andreas Pascher1
1Deopartment for General, Visceral, and Transplantation Surgery, Charité Campus Virchow Klinikum-Universitaetsmedizin Berlin, Berlin, Germany
Due to high immunosuppression, recurring allograft rejections, and altered mucosal permeability, bacterial translocation and invasive fungal infections are significant challenges after intestinal transplantation. Additionally, the small bowel is the primary target organ of Rota-, Noro- and Adenovirus, so that the timely recognition of viral infections and differentiation from cellular rejection remain difficult.
Between 06/2000 and 12/2012, 31 patients (median age 39.5±13.4 years) received an intestinal graft (n=18) or a multivisceral transplantation (n=13). We observed the 1-year postoperative course concerning bacterial, viral, and fungal infections, considering time of onset, treatment, immunosuppression, and survival.
The highest infection rate was seen in the first 3 months posttransplant. Bacterial infections (39% of patients) appeared with a peak at 4 weeks posttransplant. 46% of all bacterial infections were infections of the urinary tract, 32% blood stream, 11% wounds, 7% respiratory tract, 5% cholangitis. 60% of patients developed viral infections (peak at 12 weeks posttransplant). They were often related to antirejection therapy and included CMV-infections (64%), Rota- (17%), Adeno- (12%) and Norovirus infections (7%). Fungal infections appeared only in 4 patients (between 3 and 15 months posttransplant). All had an invasive Aspergillosis requiring triple antifungal therapy and surgical debridement. Most patients cleared their infections under efficient treatment, 2 died of infection-related multiorgan failure following bacterial pneumonia.
The reduction of initial immunosuppression and the introduction of antibacterial, antifungal, and antiviral prophylaxis helped to reduce infection rates after ITX and MVTX.
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