Intra-Abdominal Fluid Collections Following Small Bowel Transplantation

Background: IMVTX is a treatment option for patients with intestinal failure. IMVTX is often complicated by infection in the post-transplant period with the abdomen and bloodstream being the most common sites. Methods: A retrospective chart review was performed on all adult patients who underwent IMTVX at our center from 2003 to 2015. Microbiologic data was collected for up to two years’ post transplantation. Results: During the study period a total of 106 individual IMVTX were performed in 103 patients (3 patients required re-transplantation). The mean age at the time of IMVTX was 42 with 54.3% (n=56) male and 45.7% (n=47) female. There were 77 isolated small intestinal transplants and 29 multivisceral and or isolated small intestinal with liver transplants. Induction immunosuppression included either basiliximab or thymoglobulin with maintenance regimens that included tacrolimus, sirolimus, and steroids. 40% (n=43) of patients developed IAIs post IMTVX. The mean time to the first IAI was 69.9 days (range 3–696 days). Of the isolated organisms 44.7% were gram negative, 34.2% gram positive, 9.2% anaerobes, 6.2% yeast, and 6.5% no growth. The most common isolates were enterococci at 25% and e. coli and klebsiella at 12.4% each. 68.4% of the Enterococci were VRE; 36.4% of the Klebsiella and 27.3% of the E. coli were ESBL producing.93.75% of patients underwent a procedural intervention for management of the IAI. Patients were managed as follows: operative treatment (OR) plus antimicrobials (ABX) 45%, interventional radiology (IR) drainage plus ABX 35.4%, ABX alone or IR 6.25%, and 2% OR alone. The average duration of antimicrobial therapy was 22 days from the time of source control. 48% (n=51) of patients developed bloodstream infections (BSI) with a mean time to the first BSI of 124 days (range 0–641 days). There was no difference with all cause mortality in IMVTX patients with or without IAI (p=0.654); likewise, there was no difference in all cause mortality in patients with and without BSI (p=0.842). Conclusions: IAI and BSIs are common in IMVTX recipients, but despite these complications, there does not appear to be an increased risk of mortality. Aggressive management with source control and prolonged antimicrobial therapy may contribute to improved outcome of these patients.