Surgical Site Infection After Intestine Transplantation: Risk Factors and Outcomes

Infections are a significant complication of intestine transplantation. The epidemiology and impact of surgical site infections (SSIs) in this population are not well defined. This study aimed to investigate the incidence, risk factors, and outcomes of SSIs in intestine transplant recipients.

We conducted a retrospective cohort study of intestine transplant recipients at our institution from 2008-2022. SSIs were classified by CDC/NHSN criteria and evaluated in the first 30 days after transplantation. Multivariable Cox regression was used to evaluate risk factors for 30-day SSI and evaluate the association of SSI with death or allograft failure.

Among 152 intestine transplant recipients, 55 (36.2%) patients developed 30-day SSI, with 50 (90.9%) being organ/space SSI. Enterococcus faecium (62.7%) and Candida species (49.0%) were the most common organisms, and multidrug-resistant organisms (68.6%) were common. Liver-inclusive transplantation, Charlson comorbidity index ≥2, and gastrointestinal leak were associated with SSI, while vancomycin-resistant Enterococcus-active perioperative prophylaxis and pre-transplant multidrug-resistant organism colonization were not. In adjusted analysis, SSI was associated with death or allograft failure (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.04-2.82; p = 0.036), particularly within 1 year of transplantation (HR 3.30, 95% CI 1.51-7.22, p = 0.003).

SSIs are frequent and severe complications following intestine transplantation, often involving multidrug-resistant organisms. SSIs appear mostly influenced by surgical factors and complications, with liver-intestine and multivisceral recipients at the highest risk. SSI was associated with poor long-term post-transplant outcomes, primarily within the first year. Strategies to mitigate these risks are needed.