Infectious enteritis after intestinal transplantation: incidence, timing, and outcome

To review the incidence, timing, and outcome of infectious enteritis after intestinal transplantation (IT). A retrospective review of all patients undergoing IT at a single institution between 1991 and 2003 was analyze with standard statistical tools. Among 33 IT recipients, 13 (39%) developed 20 culture- or biopsy-proven episodes of infectious enteritis. The recipient demographics were 77% men and median age 2.6 years. Infections were diagnosed at a median of 76 days (32 to 1800) after IT. There were 14 viral (CMV one, rotavirus eight, adenovirus four, EBV one, three bacterial ( Clostridium difficile), and three other infections ( Giardia lamblia one, cryptosporidium two). Complete resolution was achieved in 17 (94%) infectious after appropriate antimicrobial or conservative therapy. Interestingly, there were six rejection episodes following infectious enteritis. Grafts were lost to rejection after rotaviral enteritis ( n = 1) and adenoviral enteritis misdiagnosed as rejection ( n = 1). Patient and graft survival were not adversely affected by infections. Infectious enteritis occurs frequently after IT. Viral agents are the cause in two-thirds of cases. With supportive care and appropriate treatment, resolution is possible in the majority of cases. Differentiating rejection and infection by histopathology can be difficult.