Clostridium difficile Infection in Liver Transplant Recipients: A Retrospective Study of Rates, Risk Factors and Outcomes

Clostridium difficile infection (CDI) occurs in 3-7% of liver transplant recipients (LTR). However, few data exist on the recent epidemiology, predictors and outcomes of CDI in LTR. A cohort study was performed including LTR from 2000 to 2010 at a tertiary care hospital in Detroit. CDI was defined as diarrhea with a stool C. difficile positive test. Data analyzed included demographics, comorbidities, length of stay (LOS), severity of CDI, rates of recurrence (<12 weeks), relapse (<4 weeks) and overall mortality. Predictors of CDI were calculated using Cox proportional hazard model; 970 LTR were followed for years. Overall prevalence of CDI was 18.9%. Incidence of CDI within 1 year of transplant was 12.4%. Severe CDI occurred in 29.1%. CDI recurrence and relapse rates were 16.9% and 9.7%, respectively. Independent predictors of CDI were year of transplant (hazard ratio [HR] 1.137, 95% confidence interval [CI] 1.06-1.22; p<0.001), white race (105/162 whites, HR 1.47, 95% CI 1.03-2.1; p=0.035), Model for End-Stage Liver Disease score (HR 1.03, 95% CI 1.01-1.045, p=0.003) and LOS (HR 1.01, 95% CI 1.005-1.02, p<0.001). Significant mortality was observed among LTR with CDI compared to those without CDI (p=0.003). We concluded that CDI is common among LTR and is associated with higher mortality.