CLOSTRIDIUM DIFFICILE COLITIS AFTER RENAL TRANSPLANTATION

Abstract

606 We have observed Clostridium difficile (C. diff.) colitis to be a common cause of posttx fever and/or diarrhea. The incidence of C. diff. colitis after kidney transplantation has not been studied in detail. Between 1/85 and 12/94, 1932 kidney (Ktx) or kidney/pancreas transplants (KPtx) were done(1806 patients). Of those, 159 (8.2%) developed C. diff. We reviewed available charts (n=132) to determine potential risk factors. We assessed 10 disease, age, sex, tx type, time posttx to infection, concurrent problems (e.g., infection, rejection), and treatment. Three groups were found to be at increased risk. A. Pediatric Recipients (recips) (n=43): mean age, 3.2±.6 yrs. (range 1-18 yrs.). C. diff. occurred early, usually during the initial stay (n=37, 74%); mean time to onset (±SE), 33±9 days (range 3 days to 10 mos). The 3 developing C. diff.> 6 mos were undergoing anti-rejection therapy with OKT3. Of the 43, 41 (95%) had intraabdominal placement of the graft (p<0.0001). Of the 43, 11 (26%) were being treated for UTI, 1 for catheter sepsis B. Adult Kidney Recips (n=50): mean age, 41±1.7 yrs. (range 22-63 yrs.). Only 13(26%) developed colitis during the initial stay; mean time to onset was 15±3.7 mos (range 5 days-8 yrs.). Of the 50, 21 (42%) were receiving parental antibiotics. C. Kidney-Pancreas Recips (n=39): mean age, 37.6±1.2 yrs. (range, 22-52 yrs.). Of these 21, (54%) developed C. diff. during their initial stay; mean time to onset± 1.6 mos (range 3 days to 4 mos). Of the 39, 22 (56%) were receiving antibiotics. There were 27(67%) female recips in this group (p=0.01). The overall incidence of colitis was 8% (16% in the pediatric Ktx group, 15.5% in the KPtx group, and 3.5% in the adult Ktx group). The difference in mean timing of infection was significant between the pediatric Ktx vs adult Ktx recips (p<0.001), and the pediatric Ktx vs KPtx recipient (p=0.002), but not for the adult Ktx vs KPtx recips (p=0.28). 17 (34%) of the adult Ktx and 12 (31%) of the KPtx recips group had no definable predisposing factors. Diarrhea (86-92%), fever(46-67%), and Ileus (18-28%) were the most common symptoms for each group. C. diff. was treated with vancomycin (po) or flagyl (po or iv). All recipients recovered; however, 5 (13%) KPtx recips had recurrence. Recipient ages, sex, treatment of rejection, antibiotic use, and area of graft placement have been shown to increase the incidence of this disease. The incidence of C diff. colitis is increased in the pediatric Ktx recips and the KPtx recips. Prophylaxis with oral vancomycin may decrease the incidence of colitis in these 2 groups.