Clostridioides difficile (formerly Clostridium difficile) infection (CDI) is highly prevalent among solid organ transplant (SOT) recipients and develops early in the post-transplant period, according to data presented at the 2019 American Transplant Congress in Boston. CDI in this population is usually severe and associated with a high rate of recurrence and increased mortality.

In a study of 2622 SOT recipients, Aaron M. Schluger, MD, and colleagues at Columbia University Irving Medical Center in New York found that 224 (8.5%) experienced CDI within 1 year post-transplant, and 64% experienced severe CDI. The investigators defined CDI as the presence of bloody diarrhea and positive stool C. difficile polymerase chain reaction findings.

Pancreas recipients had the highest CDI incidence (12.5%), followed by lung (11.7%), liver (11%), heart (10.8%), and kidney (5.8%) recipients, Dr Schluger’s team reported in a poster presentation. The median time to CDI was 56 days post-SOT. It was 21 days for pancreas, 5 days for liver, 43 days for heart, 44 days for kidney, and 106 days for lung.

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Pancreas, liver, and lung transplant recipients had a significant 1.5-, 2.6-, 2.0-, and 2.1-fold increased risk of CDI, respectively, compared with kidney transplant recipients, on multivariable analysis. Initial CDI following SOT was significantly associated with a 2-fold increased risk of death.

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Recurrent CDI developed in 28.6% of patients. Lung transplantation was significantly associated with 5-fold increased odds of recurrent CDI, after controlling for age, severe CKD, pre-SOT CDI and oral vancomycin use.

Of the patients with CDI, 56.3% were treated with metronidazole, 13.8% oral vancomycin, and 28.6% with both.

The authors concluded that the early post-transplant period may be a crucial window to decrease CDI rates.


Schluger A, Rosenblatt R, Knotts R, et al. Clostridioides difficile infection and recurrence among 2,622 solid organ transplant recipients. Presented at the 2019 American Transplant Congress in Boston, June 1 to 4. Abstract A347