Transcript Poster_intestino_final_03

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INFECTIONS ASSOCIATED TO INTESTINAL AND
MULTIVISCERAL TRANSPLANTATION: AN EIGHT YEAR
EXPERIENCE AT A SINGLE CENTER
E. Madsen, C. Condori, H. Solar, G. Gondolesi, S. Martini Novas, A. Diaz Armas,
A. Fernandez, P. Andres, A. Cabanne, C. Nagel ([email protected])
OBJECTIVES
Our aim is to analyze infectious episodes (ie) in the adult I/MTV transplants
performed at our center.
MATERIALS AND METHODS
Retrospective review of 14 adult I/MTV transplants performed between 5/2006 and
12/2014. 12 patients (pt) that survived > 72 hs were included: 10 isolate I, 1 MTV and
1 modified MTV.
Inmunosupressive regime was as induction: basiliximab or ALG; manteinance:
FK+antiproliferative agent+steroids.
All pt received prophylaxis: perioperative antibiotics 5 days (ds); antifungal 1 month;
for PCP 1 year (y); for CMV 3-6 months and preemptive treatment for EBV 1 y.
RESULTS
Mean time from
the transplant to
the ie (mtft/ie)
Bacterial 70.4
667.7 ds
TYPE OF
INF
%
Viral
20.4
615.1 ds
Mycotic
11.4
496.1 ds
Parasitic
2.3
81 ds
- Re-operations for non infectious causes:4/12 (30%) pt
- Mean time of post transplant (ptx) permanence of
parenteral nutrition catheter: 45 ds  49.3
- 11/12 pt (91.7%) had 44 ie; 1 ie: in 27.3%; ≥ 2 and ≤ 4
ie: in 27.3% and > 4 ie: in 45.5% pt.
- 74.2% of bacterial ie took place > 60 ds ptx. This was
related to: prolonged postoperative hospital (h) stay
(45.2%), need of frequent h readmissions for non inf
causes (32.2%) and late community acquired inf (22.6%)
- Bacteria isolated: 26 (61.9%) gram
negative rods and 16 (38.1%) gram
positive bacteria. 21 (50%) were
multidrug resistant pathogens
(mdrp) including carbapenem
resistant Klebsiella pneumoniae ,
isolated from multiple sites in 2 pt
causing their death. These ie were
preceded by pre or ptx prolonged h
stay, antibiotic treatments, known
colonization or need of reoperations.
- Fungal ie documented: 5/4 pt: 4 Candida spp, 1 Criptococcus neoformans.
- Viral ie documented: 9/7 pt and were due to: CMV: 4; Parainfluenza:1;Influenza A: 1; HPV: 1;
HHV8: 1; Rotavirus: 1; with allograft enteritis in 5 of them. Parasitic ie: 1 Isospora belli.
- 9/12 pt had 31 episodes of acute cellular rejection (eACR); 2.6 episodes/pt; being 29.5% of
ie preceded by eACR.
- Mean time of follow up:1227.7 ds. In 4/8 pt (50%) inf was the attributable cause of death.
- Graft and pt survival was at: 1 y 83%; 3 y 66%; 5 y 53%.
CONCLUSIONS
- Like others, we observed that the classic timeline of ie for solid organs did
not apply for I/MTV transplants.
- Infections had a profound negative impact in pt outcome.
- In these adult population viral enteritis did not cause graft nor pt loss.
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