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• W2978220272 abstract "Introduction: Solid organ transplantation is a known risk factor for C difficile infection (CDI). However, published data comparing CDI in pre- and post-liver transplant patients is sparse. In this study, we compared the prevalence, risk factors, and outcomes of newly acquired CDI in hospitalized patients who were wait-listed for orthotopic liver transplant (OLT) with those status-post OLT. Methods: We conducted a retrospective study using a liver transplant database and identified hospitalized patients at Montefiore Medical Center with a positive C. difficile toxin assay from 2008 to 2015. Two cohorts were compared: listed patients with CDI and transplanted patients with CDI. For each patient, we catalogued demographics, pre-CDI medication exposure, length of hospital stay (LOS), 30-day readmission, and 30-day mortality. We also collected lab to calculate Model End-Stage Liver Disease (MELD) score, MELD-sodium score (MELD-Na), and CDI severity. Results: Of 35 total patients with CDI, 18 were listed and 17 transplanted (see Table 1). The prevalence of CDI was similar in transplanted and listed patients (10.0% vs 6.6%; p=0.20). There were no significant differences in age and gender. The severity of CDI was significantly different between groups (p < 0.01) with more complicated cases of CDI in the listed group. As expected, median MELD-Na and MELD scores were significantly lower in transplanted patients compared with listed patients (15 vs. 23 and 13 vs. 22, respectively; p < 0.01). There was a trend toward increased 30-day readmission rates for any indication in transplanted compared to listed patients (70.6% vs. 38.9%, p=0.06). LOS, 30-day readmission for CDI, and 30-day mortality were not significantly different between groups. Transplanted patients had significantly increased exposure to immunosuppressants (p < 0.001) and glucocorticoids (p < 0.001), but no significant differences in antibiotic and proton pump inhibitor exposure were found.Table 1: Characteristics of study population and bivariate associations in listed and transplanted patients with CDI*Conclusion: Although OLT recipients had similar rates of CDI, its severity was significantly worse in patients awaiting liver transplant. Patients who were listed for transplantation tend to have higher MELD scores than those that are post-OLT and may have more severe outcomes as a result. Physicians might not expect wait-listed liver patients to be nearly as sick as liver transplant patients who are immunosuppressed, but our findings suggest that wait-listed patients may require earlier, more aggressive treatment." @default.
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• W2978220272 date "2016-10-01" @default.
• W2978220272 modified "2023-10-18" @default.
• W2978220272 title "Severity of Newly Acquired C. Difficile (CDI) Is Worse in Hospitalized Patients Wait-listed for a Liver Than in Hospitalized Patients After Liver Transplantation" @default.
• W2978220272 doi "https://doi.org/10.14309/00000434-201610001-00849" @default.
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