Early Infections after Intestinal Transplantation in Adults. A Comparison with Liver Transplantation

Introduction: Infections are a leading cause of morbidity and mortality after intestinal (ITx). Although the infection risk is perceived as higher than with other types of transplants, any direct comparisons are lacking. Herein, we analysed the infectious complications during the first year after ITx and compared it with those occurring after liver transplantation (LTx).z Methods: We reviewed all adult ITx (n=28) performed at Sahlgrenska University Hospital between 2000-2022 and retrieved data on type, timing, etiology and management of infections. Similar data were collected on all adult LTx performed during 2017 at the same centre (n=73). Results: Eighty-nine percent of ITx developed at least one infection during the first year post-transplant compared to 62% of LTx (p<0.01). About half of these infections occurred within three months and bacterial infections were the most common (64% and 70% for ITx and LTx, respectively). Bloodstream/sepsis (35% vs. 9.8%, p<0.001) and abscesses (10.3% vs 6.5%, p<0.01) were more frequent in ITx, whereas cholangitis (3.4 vs. 21.6%) and respiratory infections (9.4 vs. 14.1%) were numerically more prevalent in LTx. Infections were the leading cause of mortality in both groups. Overall, the risk of infections was higher in ITx compared with LTx (RR 1.44, 95% CI, 1.151 to 1.805, p=0.001). ITx receiving a similar immunosuppressive regimen (basiliximab induction, tacrolimus @ 10-12 ng/mL, mycophenolate mofetil, steroids) with LTx had a higher infection risk compared with the LTx (RR 1.622, 95% CI, 1.353 to 1.944, p<0.001). Conclusions: Infections are almost universal after intestinal transplantation, with a majority occurring in the early post-transplant period. Recipients of intestinal transplants had a higher incidence and risk of infection than recipients of liver transplants. Further research and efforts to refine infection prophylaxis and management as well as understanding its relationship with immunosuppression are needed to improve outcomes after intestinal transplantation. Figure: Timeline of infections according to etiology following intestinal transplantation (upper panel) and liver transplantation (lower panel).