Early and late onset Clostridium difficile-associated colitis following liver transplantation
Early and late onset Clostridium difficile-associated colitis following liver transplantation
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DOI：
10.1111/j.1432-2277.2007.00530.x
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发表时间：
2007-10-01
影响因子：
3.1
通讯作者：
Hellinger, Walter
中科院分区：
文献类型：
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作者：
Albright, Jeffrey B.;Bonatti, Hugo;Hellinger, Walter
艰难梭菌结肠炎（CDC）仍然是肝移植（LT）后严重且常见的并发症。 1998 年至 2001 年间，我们中心对 402 人进行了 467 次连续 LT 手术。标准免疫抑制剂包括他克莫司、麦考酚酯和类固醇。 CD毒素A和B通过快速免疫测定或酶免疫测定来检测。 32 名患者（LT 后 5-1999 天）被诊断出 CDC，其中 93.8% (30/32) 的患者在 LT 后第一年出现 CDC；三名患者在 LT 后 3 年以上患有 CDC，其中一名患者也患有早期 CDC。所有患者均出现腹痛和水样腹泻。 LT 后 1 年内出现 CDC 的患者出现出血、胆道或感染并发症的可能性明显更高。 LT 后 28 天内出现 CDC 的患者的模型终末期肝病评分显着较高。治疗包括液体和电解质补充以及甲硝唑，没有患者出现中毒性巨结肠、需要结肠切除术或死于 CDC。 CDC 代表 LT 后潜在的严重并发症。大多数病例发生在 LT 后早期。出血性、胆道性或感染性并发症的发生与 CDC 的发生有关。
Clostridium difficile colitis (CDC) remains a serious and common complication after liver transplantation (LT). Four hundred and sixty-seven consecutive LTs in 402 individuals were performed between 1998 and 2001 at our center. Standard immunosuppression consisted of tacrolimus, mycophenolate, and steroids. CD toxins A and B were detected by using a rapid immunoassay or enzyme immunoassay. CDC was diagnosed in 32 patients (5-1999 days post-LT), with 93.8% (30/32) of patients developing CDC during the first year post-LT; three individuals had CDC more than 3 years post-LT, one of which also had early CDC. All patients presented with abdominal pain and watery diarrhea. Patients who developed CDC within 1-year post-LT were significantly more likely to have a hemorrhagic, biliary, or infectious complication. Patients who developed CDC within 28 days post-LT had a significantly higher model end-stage liver disease score. Treatment consisted of fluid and electrolyte replacement and metronidazole and no patients developed toxic megacolon, required colonic resection, or died from CDC. CDC represents a potentially severe complication following LT. Most cases occur early post-LT. Development of a hemorrhagic, biliary, or infectious complication is associated with the development of CDC.