Clostridium difficile colitis after kidney and kidney-pancreas transplantation

Objective - To determine the timing and risk factors involved in the develo pment of Clostridium difficile (CD) colitis in kidney and kidney-pancreas t ransplant recipients. Summary background data - The incidence of CD colitis after kidney and kidn ey-pancreas transplantation has not been studied in detail. The question of whether the immunosuppressed transplant recipient is more prone to CD coli tis and its complications (i.e., megacolon, perforations) and the risk fact ors involved have not been determined. Methods - We retrospectively reviewed our experience in kidney and kidney-p ancreas recipients who received transplants between January 1, 1985 and Dec ember 31, 1994. We divided these recipients into three groups: pediatric ki dney recipients, adult kidney recipients, and kidney-pancreas recipients. F or each group, we assessed the timing of infection, primary disease, coliti s treatment, and any concurrent complications or risk factors. Results - Of 1932 transplants, 159 recipients developed post-transplant CD colitis. 132 charts were available for review. Forty-three pediatric kidney recipients developed CD colitis. Their mean age was 3.2 yr; 74% (n = 37) o f them developed their colitis during their initial hospital stay, with the mean timing of infection being 33 d. Forty-one (95%) had undergone intra-a bdominal placement of the graft, with renal artery anastomoses to the aorta . Fifty adult kidney recipients developed CD colitis. Thirteen (26%) develope d colitis during their initial hospital stay, with the mean timing of infec tion (for all adult kidney recipients) being 15 months. Thirty-nine kidney- pancreas recipients developed CD colitis. Mean timing of infection was 6 mo nths. The overall incidence of CD colitis was 8%. with 16% in the pediatric kidne y group, 15.5% in the kidney-pancreas group, and 3.5% in the adult kidney g roup. The difference in mean timing of infection was significant between th e three groups (p < 0.001 for pediatric versus adult kidney recipients, p = 0.002 for pediatric kidney versus kidney-pancreas recipients, and p = 0.28 46 for adult kidney versus kidney-pancreas recipients). Conclusion - The incidence of CD colitis is increased in pediatric kidney a nd kidney-pancreas recipients. Young recipient age (< 5 yr), female gender, treatment of rejection with monoclonal antibodies, antibiotic use, and int ra-abdominal graft placement have been shown to increase the incidence of t his disease. Further studies concerning prevention in the high-risk groups are needed.