Postoperative Infections Following Intestinal Transplantation

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IntroductionDue to high immunosuppression, recurring allograft rejections, and altered mucosal permeability, bacterial translocation and invasive fungal infections are significant challenges after intestinal transplantation. Additionally, the small bowel is the primary target organ of Rota-, Noro- and Adenovirus, so that the timely recognition of viral infections and differentiation from cellular rejection remain difficult.Methods31 patients (median age 39.5±13.4 years) received an intestinal graft (n=18) or a multivisceral transplantation (n=13). We observed the 1-year postoperative course concerning bacterial, viral, and fungal infections, considering time of onset, treatment, immunosuppression, and survival.ResultsMost infections developed within 3 months posttransplant. Bacterial infections (39% of patients) appeared with a peak at 4 weeks. 46% were infections of the urinary tract, 32% blood stream, 11% wounds, 7% respiratory tract, 5% cholangitis. 60% of patients developed viral infections (peak 3 months posttransplant). They were often related to antirejection therapy and included CMV-infections (64%), Rota- (17%), Adeno- (12%) and Norovirus infections (7%). 4 patients developed invasive Aspergillosis within the first year, requiring triple antifungal therapy, and surgical debridement. Most patients cleared their infections under efficient treatment, 2 died of infection-related multiorgan failure following bacterial pneumonia.ConclusionThe reduction of initial immunosuppression and the introduction of antibacterial, antifungal, and antiviral prophylaxis helped to reduce infection rates after intestinal and multivisceral transplantation.

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