Bacterial infections after intestine and multivisceral transplantation. The experience of the University of Miami (1994-2001)

Abstract

Background/aims: Bacterial infections (BI) are frequent after intestinal transplantation (ITx). Bacteremia, intraabdominal and respiratory infections are the leading forms. The objective of this study is to analyze the occurrence, determinants and outcome of BI.

Methodology: One hundred and twenty-four patients with ITx (39 isolated, 33 liver-intestine, 63 multivisceral). Only major BI were considered, including bacteremia, pneumonia, intraabdominal infections, severe wound infections.

Results: BI occurred in 92.7% of patients during follow-up, with an average of 2.9 episodes per patient. Bacteremia was the commonest picture (1.7 per patient). More than 80% of patients had a BI before the end of the second month. Multivariate analysis showed that the presence of BI was higher during the first 2 months after Itx in patients hospitalized before Tx [p=0.029, odds ratio (OR) 5.4] and during months 3 to 6 in those treated with Zenapax (p=0.003, OR 6.2). Occurrence of BI was increased with mycophenolate mofetil treatment (p=0.045 OR 4.2). Intraabdominal infection was more frequent when reTx was needed (p=0.0178 OR 15.2), admission before Tx (p=0.034 OR 2.7), IS with MMF (p=0.004 OR 6.2) and Zenapax (p=0.026 OR 3.6). BI was the direct cause of death in 17.8% of patients, and it was present in 76.2% of patients that died. An infectious episode during the first month, a clinically manifested abdominal infection and a positive intraabdominal culture were determinants of shorter patient survival.

Conclusions: BI continue to be a frequent and dreadful complication after ITx. Pretransplant patient condition, IS used and postoperative complications are crucial on BI onset and outcome.