Posttransplant complications in adult recipients of intestine grafts without bowel decontamination

Jared W. Clouse, Chandrashekhar A. Kubal, Jonathan A. Fridell, Richard Mangus

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Selective digestive decontamination is commonly used to decrease lumenal bacterial flora. Preoperative bowel decontamination may be associated with a lower wound infection rate but has not been shown to decrease risk of intra-abdominal abscess or lower leak rate for enteric anastomoses. Alternatively, the decontamination disrupts the normal flora of the gastrointestinal tract and may affect normal physiology, including immunologic function. This study reports complication rates of an intestine transplant program that has never used bowel decontamination. Methods: All adult patients who underwent intestine transplant from 2003 to 2015 at a single center were reviewed. Posttransplant complications included intra-abdominal abscess, enteric fistula, and leak from the enteric anastomosis. Viral, fungal, and bacterial infections in the first year after transplant are reported. Results: There were 184 adult patients who underwent deceased donor intestine transplant during the study period. Among these patients, 30% developed an infected postoperative fluid collection, 4 developed an enteric fistula (2%), and 16 had an enteric or anastomotic leak (8%). The rate of any bacterial infection was 91% in the first year, with a wound infection rate of 25%. Fungal infection occurred in 47% of patients. Rejection rates were 55% at 1 y for isolated intestine patients and 17% for multivisceral (liver inclusive) patients. Conclusions: Among this population of intestine transplant patients in which no bowel decontamination was used, rates of surgical complications, infections, and rejection were similar to those reported by other centers. Bowel decontamination provides no identifiable benefit in intestine transplantation.

Original languageEnglish (US)
Pages (from-to)125-130
Number of pages6
JournalJournal of Surgical Research
Volume225
DOIs
StatePublished - May 1 2018

Fingerprint

Decontamination
Intestines
Transplants
Abdominal Abscess
Mycoses
Wound Infection
Bacterial Infections
Fistula
Anastomotic Leak
Virus Diseases
Gastrointestinal Tract
Transplantation
Tissue Donors
Liver
Infection
Population

Keywords

  • Bowel preparation
  • Complications
  • Gut decontamination
  • Intestine transplant
  • Multivisceral transplant
  • Outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Posttransplant complications in adult recipients of intestine grafts without bowel decontamination. / Clouse, Jared W.; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Mangus, Richard.

In: Journal of Surgical Research, Vol. 225, 01.05.2018, p. 125-130.

Research output: Contribution to journalArticle

Clouse, Jared W. ; Kubal, Chandrashekhar A. ; Fridell, Jonathan A. ; Mangus, Richard. / Posttransplant complications in adult recipients of intestine grafts without bowel decontamination. In: Journal of Surgical Research. 2018 ; Vol. 225. pp. 125-130.
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abstract = "Background: Selective digestive decontamination is commonly used to decrease lumenal bacterial flora. Preoperative bowel decontamination may be associated with a lower wound infection rate but has not been shown to decrease risk of intra-abdominal abscess or lower leak rate for enteric anastomoses. Alternatively, the decontamination disrupts the normal flora of the gastrointestinal tract and may affect normal physiology, including immunologic function. This study reports complication rates of an intestine transplant program that has never used bowel decontamination. Methods: All adult patients who underwent intestine transplant from 2003 to 2015 at a single center were reviewed. Posttransplant complications included intra-abdominal abscess, enteric fistula, and leak from the enteric anastomosis. Viral, fungal, and bacterial infections in the first year after transplant are reported. Results: There were 184 adult patients who underwent deceased donor intestine transplant during the study period. Among these patients, 30{\%} developed an infected postoperative fluid collection, 4 developed an enteric fistula (2{\%}), and 16 had an enteric or anastomotic leak (8{\%}). The rate of any bacterial infection was 91{\%} in the first year, with a wound infection rate of 25{\%}. Fungal infection occurred in 47{\%} of patients. Rejection rates were 55{\%} at 1 y for isolated intestine patients and 17{\%} for multivisceral (liver inclusive) patients. Conclusions: Among this population of intestine transplant patients in which no bowel decontamination was used, rates of surgical complications, infections, and rejection were similar to those reported by other centers. Bowel decontamination provides no identifiable benefit in intestine transplantation.",
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