Correspondence

Infection in Solid-Organ Transplant Recipients

N Engl J Med 2008; 358:1302March 20, 2008

Article

To the Editor:

In his review of infections in recipients of solid-organ transplants, Fishman (Dec. 20 issue)1 discusses Clostridium difficile diarrhea in the immediate post-transplantation period. Although this infection has been reported previously in liver-transplant recipients,2 there is mounting evidence that gastric acid suppression may be implicated in this infection both in the community and in hospitalized patients,3,4 including patients with cirrhosis.5 In many institutions that perform transplantation, it is standard practice to prescribe proton-pump inhibitors in the immediate post-transplantation period in order to provide protection against stress ulceration and bleeding in the intensive care setting and subsequently as prophylaxis against ulceration for the duration of a tapering course of corticosteroids. Clinicians need to weigh the risk of life-threatening upper gastrointestinal bleeding against the consequences of potentially unnecessary gastric acid suppression. A potential strategy may be to limit gastric acid suppression to the intensive care unit and to reduce the use of corticosteroids in immunosuppression.

Timothy J.S. Cross, B.Med.Sci.
Phillip A. Berry, B.Sc.
Andrew K. Burroughs, M.B., Ch.B.
Royal Free Hospital, London NW3 2OQ, United Kingdom
tjscross@hotmail.com

5 References

1. 1

   Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357:2601-2614
   Full Text | Web of Science | Medline

2. 2

   Albright JB, Bonatti H, Mendez J, et al. Early and late onset clostridium difficile-associated colitis following liver transplantation. Transpl Int 2007;20:856-866
   CrossRef | Web of Science | Medline

3. 3

   Dial S, Delaney JAC, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005;294:2989-2995
   CrossRef | Web of Science | Medline

4. 4

   Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004;171:33-38
   CrossRef | Web of Science | Medline

5. 5

   Bajaj JS, Zadvornova Y, Hafeezullah M, Saeian K. Clostridium difficile infection is associated with proton pump inhibitors in patients with cirrhosis. Hepatology 2007;46:Suppl:580A-580A
   Web of Science

Citing Articles (4)

Citing Articles

1. 1

   Bert-Jan F. de Rooij, Bart van Hoek, W. Rogier ten Hove, Anja Roos, Lee H. Bouwman, Alexander F. Schaapherder, Robert J. Porte, Mohamed R. Daha, Johan J. van der Reijden, Minneke J. Coenraad, Jan Ringers, Andrzej G. Baranski, Bouke G. Hepkema, Daniel W. Hommes, Hein W. Verspaget. (2010) Lectin complement pathway gene profile of donor and recipient determine the risk of bacterial infections after orthotopic liver transplantation. Hepatology 52:3, 1100-1110
   CrossRef

2. 2

   Jasmohan S Bajaj, Ashwin N Ananthakrishnan, Muhammad Hafeezullah, Yelena Zadvornova, Alexis Dye, Emily L McGinley, Kia Saeian, Douglas Heuman, Arun J Sanyal, Raymond G Hoffmann. (2010) Clostridium difficile Is Associated With Poor Outcomes in Patients With Cirrhosis: A National and Tertiary Center Perspective. The American Journal of Gastroenterology 105:1, 106-113
   CrossRef

3. 3

   Anett Hoppe, Manja Kamprad, Claudia Wegmann, Michael Wötzel, Johann Hauss, Frank Emmrich, Josef Fangmann, Ulrich Sack. (2008) Natürliche Killerzellen und Natürliche Killer-T-Zellen bei Nierentransplantation / Natural killer cells and natural killer-T cells in patients with renal transplantation. LaboratoriumsMedizin 32:3, 140-147
   CrossRef

4. 4

   Anett Hoppe, Manja Kamprad, Claudia Wegmann, Michael Wötzel, Johann Hauss, Frank Emmrich, Josef Fangmann, Ulrich Sack. (2008) Natural killer cells and natural killer T cells in patients with renal transplantation ¹. LaboratoriumsMedizin 32:3, ---
   CrossRef