Sullivan Timothy, Weinberg Alan, Rana Meenakshi, Patel Gopi, Huprikar Shirish
1 Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY. 2 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Transplantation. 2016 Sep;100(9):1939-43. doi: 10.1097/TP.0000000000001309.
Clostridium difficile infection (CDI) is common after liver transplantation (LT); however, few studies have examined the risk factors, clinical manifestations, and outcomes of CDI in this population.
A retrospective study of adults who underwent LT between January 1, 2011, and April 4, 2013, at The Mount Sinai Hospital was conducted. Potential risk factors were evaluated via univariate and multivariable analysis to determine predictors of CDI in this population. The clinical manifestations of CDI and patient outcomes were also reviewed.
Clostridium difficile infection occurred in 27 (14%) of 192 patients after LT. In multivariable analysis, CDI was associated with having a model for end-stage liver disease score of 20 or greater (hazards ratio, 2.90; 95% confidence interval, 1.29-6.52; P = 0.010), and receiving a LT from a living donor (hazards ratio, 3.77; 95% confidence interval, 1.47-9.67; P = 0.006). Forty-one percent of CDI cases occurred within 1 week of LT. Seven percent of patients with CDI had a serum white blood cell count greater than 12 000 cells per μL, and 26% had a temperature greater than 38.0°C. After treatment 6 (22%) patients developed CDI relapse, and all were successfully treated. No patients died of CDI after a mean follow-up time of 1.8 years; however, overall survival was significantly lower among those with CDI (78% vs 92%; P = 0.033).
Clostridium difficile infection after LT was associated with higher model for end-stage liver disease scores and receiving a LT from a living donor. Clostridium difficile infection often occurred soon after LT and was infrequently associated with leukocytosis or fever. Clostridium difficile infection in LT recipients was associated with lower overall survival.
艰难梭菌感染（CDI）在肝移植（LT）后很常见；然而，很少有研究探讨该人群中CDI的危险因素、临床表现及预后。
对2011年1月1日至2013年4月4日在西奈山医院接受LT的成人进行回顾性研究。通过单因素和多因素分析评估潜在危险因素，以确定该人群中CDI的预测因素。还对CDI的临床表现和患者预后进行了回顾。
192例LT术后患者中有27例（14%）发生艰难梭菌感染。多因素分析显示，CDI与终末期肝病模型评分≥20（风险比，2.90；95%置信区间，1.29 - 6.52；P = 0.010）以及接受活体供肝的LT（风险比，3.77；95%置信区间，1.47 - 9.67；P = 0.006）相关。41%的CDI病例发生在LT后1周内。7%的CDI患者血清白细胞计数>12000/μL，26%的患者体温>38.0°C。治疗后6例（22%）患者发生CDI复发，均成功治愈。平均随访1.8年后，无患者死于CDI；然而，CDI患者的总体生存率显著较低（78%对92%；P = 0.033）。
LT后艰难梭菌感染与较高的终末期肝病模型评分以及接受活体供肝的LT相关。艰难梭菌感染常发生在LT后不久，很少与白细胞增多或发热相关。LT受者中的艰难梭菌感染与较低的总体生存率相关。
