Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain.
Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain.
Am J Transplant. 2016 Mar;16(3):951-9. doi: 10.1111/ajt.13535. Epub 2015 Nov 11.
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.
小肠移植（SBT）后感染并发症的微生物谱和结果尚未得到充分描述。我们对 2004 年至 2013 年期间在西班牙接受 SBT 的所有患者进行了回顾性分析。69 名患者共接受了 87 例 SBT 手术（65 例儿科，22 例成人）。中位随访时间为 867 天。总体而言，81 名移植患者（93.1%）发生了 263 次感染（感染发生率：每 1000 个移植日发生 2.81 次），成人和儿科人群之间没有显著差异。大多数感染是细菌感染（47.5%）。尽管进行了普遍预防，但仍有 22 名移植患者（25.3%）发生了巨细胞病毒疾病，主要表现为肠炎。具体而言，35 名移植患者发生了 54 次机会性感染（OI）。感染是导致死亡的主要原因（24 例死亡中有 17 例）。多变量分析确定了再次移植（风险比[HR]：2.21；95%置信区间[CI]：1.02-4.80；p=0.046）和移植后肾替代治疗（RRT；HR：4.19；95%CI：1.40-12.60；p=0.011）是 OI 的危险因素。RRT 也是侵袭性真菌感染（IFD）的危险因素（HR：24.90；95%CI：5.35-115.91；p<0.001）。总之，感染是 SBT 后最常见的并发症和死亡原因。移植后 RRT 和再次移植可识别出那些发生 OI 和 IFD 风险较高的受者。
