131. A Multicenter Study on Clinical Outcomes of Infections within 200 days of Liver Transplantation among Recipients age 65 years and older
Session: Oral Abstract Session: Infections in Transplantation
Thursday, October 5, 2017: 10:45 AM
Room: 05AB
Background: Liver transplantation is increasingly performed in patients ≥65 years. Per the United Network for Organ Sharing data, infections are the leading primary and contributory cause of death in older liver transplant (LT) recipients. This study aims to describe the epidemiology and outcomes of infections within the first 200 days of LT in older adults.

Methods: We performed a retrospective, observational multi-center study of patients age ≥65 years who underwent primary LT from January 1,2010 to June 30,2015. Data collection included patient demographics, co-morbidities, transplant data, infection event in 200 days of LT and death. Severe infection was defined as the presence of sepsis, septic shock or sepsis with multi-organ failure.

Results: A total of 255 patients met inclusion criteria with median follow up of 690 days (range 1- 2095). The mean age was 67.6 years (SD 2.4). Majority were male (67%) and white (85%). Frequent indications of LT were hepatocellular carcinoma (46%) and hepatitis C (32%). The median MELD score at the time of LT was 22 (range 6-47). Only 3% of recipients received thymoglobulin for induction. Acute rejection within 200 days of LT occurred in 31 (12%); graft failure in 8 (3%) and re-transplantation in 5 (2%).

One hundred twenty-seven patients (50%) developed a total of 274 infections; 63 (25%) had 1 infection and 64 (25%) had ≥ 2 infections. Median time to first infection after LT was 26 days [IQR 9-72]. Out of 274 infections, 182 (66%) occurred in < 90 days. Severe infection occurred in 40/127 (31%). Cystitis (16%), colitis (12%) and pneumonia (11%) were common. Bacterial, viral and fungal infections were 61%, 22% and 7%, respectively. Common bacterial pathogens were Enterococcus sp. (15%), Clostridium difficile (12%) and E. coli (8%). 35 (13%) opportunistic infections (OI) occurred due to Cytomegalovirus [CMV] (26), Candida (4), Cryptococcus (3), HHV-8 (1), and Aspergillus (1). Mortality due to infection was 3%, while all-cause mortality was 12%. Frequency of discharge to sub-acute or extended care facility after infection was 23%.

Conclusion: Infections are common in this older LT cohort and occurred mainly in the early post-LT period. OIs were infrequent except for CMV. Despite concerns for immunosuppression and immunosenescence, the outcome of infection within the 200 days of LT was overall favorable.

Maricar Malinis, MD, FACP, FIDSA, Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, Tue Ngo, MD, Medical University of South Carolina, Charleston, SC, Julia Garcia-Diaz, MD, FIDSA, Infectious Diseases, Ochsner Clinic Foundation, New Orleans, LA, Sarah Taimur, MD, Icahn School of Medicine at Mount Sinai, New York, NY, Nicolas Mueller, MD, University Hospital Zurich, Zurich, Switzerland, Albert Eid, MD, Infectious Diseases, University of Kansas Medical Center, Kansas City, KS, Pascalis Vergidis, MD, MSc, University Hospital of South Manchester, University of Manchester, Manchester, United Kingdom, Kenneth Pursell, MD, FIDSA, Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL, Archana Bhaskaran, MD, University of Minnesota, Minneapolis, MN, Ricardo La Hoz, MD, FACP, FAST, University of Texas Southwestern Medical Center, Dallas, TX, Andres Bran, MD, Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, Dong Lee, MD, Infectious Diseases & HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, Stephanie Pouch, MD, MS, Department of Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, Robin Avery, MD, FIDSA, Johns Hopkins University, Baltimore, MD, John W. Baddley, MD, University of Alabama at Birmingham, Birmingham, AL and American Society of Transplantation Infectious Diseases Community of Practice

Disclosures:

M. Malinis, None

T. Ngo, None

J. Garcia-Diaz, None

S. Taimur, None

N. Mueller, None

A. Eid, None

P. Vergidis, None

K. Pursell, None

A. Bhaskaran, None

R. La Hoz, None

A. Bran, None

D. Lee, None

S. Pouch, None

R. Avery, None

J. W. Baddley, None

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