TY - JOUR
T1 - Early and late onset Clostridium difficile-associated colitis following liver transplantation
AU - Albright, Jeffrey B.
AU - Bonatti, Hugo
AU - Mendez, Julio
AU - Kramer, David
AU - Stauffer, John
AU - Hinder, Ronald
AU - Michel, Jaime A.
AU - Dickson, Rolland C.
AU - Hughes, Chris
AU - Nguyen, Justin
AU - Chua, Heidi
AU - Hellinger, Walter
PY - 2007/10
Y1 - 2007/10
N2 - 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.
AB - 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.
KW - Clostridium difficile
KW - Liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=34548595263&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548595263&partnerID=8YFLogxK
U2 - 10.1111/j.1432-2277.2007.00530.x
DO - 10.1111/j.1432-2277.2007.00530.x
M3 - Article
C2 - 17854444
AN - SCOPUS:34548595263
SN - 0934-0874
VL - 20
SP - 856
EP - 866
JO - Transplant International
JF - Transplant International
IS - 10
ER -