MP85-11 ARE KIDNEY TRANSPLANT PATIENTS WITH CLOSTRIDIUM DIFFICILE COLITIS AT INCREASED RISK FOR REJECTION?

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2015MP85-11 ARE KIDNEY TRANSPLANT PATIENTS WITH CLOSTRIDIUM DIFFICILE COLITIS AT INCREASED RISK FOR REJECTION? Chad A. Reichard, Samuel C. Haywood, and Daniel A. Shoskes Chad A. ReichardChad A. Reichard More articles by this author , Samuel C. HaywoodSamuel C. Haywood More articles by this author , and Daniel A. ShoskesDaniel A. Shoskes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies of clostridium difficile (C. diff) infection have focused on infection risk factors and outcome with an average reported incidence in the literature of 7-9%. There is evidence from animal studies that C. diff in the gut microbiome can increase innate and specific immunity leading to an increased immune response. Therefore, we hypothesized that the risk of rejection may be increased subsequent to C. diff infection, and aimed to determine whether temporal rejection rates were higher in patients with prior history of C. diff. Since the standard therapeutic intervention for severe infection is immunosuppression reduction, we also were interested in any increased rates of rejection overall (early or late). METHODS Retrospective review of 1604 patients that underwent kidney transplantation at our institution from 2004-2014 was performed. There were a total of 90 (5.6%) patients with documented C. diff infections and 215 (13.4%) with documented rejection. Patients with C. diff were matched to a historical cohort similar in age and induction immunosuppression of patients without history of C. diff. RESULTS Mean age in the C. diff positive vs. C. diff negative groups was 48.4±15.7 vs. 49±13.9 (p=0.71). In the C. diff negative group, 197 (13%) patients had rejection episodes versus 18 (20%) of patients with history of C. diff (p=0.05). However, in the C. diff group, only 6 rejection episodes occurred subsequent to a C. diff infection (6/90 =6.7%) p=0.10. Rejection episodes occurred a mean of 672 days (median 441, range 111-1780) after C diff infection. CONCLUSIONS C. diff infection rates with our institutional immunosuppression and antimicrobial protocol are lower than reported in the literature. Despite potential change in the microbiome from C. diff infection, there appears to be no increased risk of rejection subsequent to infection. While not specifically addressed in this study design, our data appear to support the relative safety of immunosuppression minimization in the setting of infectious diarrhea. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1070-e1071 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chad A. Reichard More articles by this author Samuel C. Haywood More articles by this author Daniel A. Shoskes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...