Background: VRE infections are associated with higher morbidity and mortality among patients undergoing liver transplantation.

Objective: The primary outcome is to examine the association between Endoscopic Retrograde Cholangio-Pancreatography (ERCP) and VRE infection post-transplant. The secondary outcome is to determine baseline VRE colonization rates in our patients.

Methods: Recipients undergoing liver transplantation between 1/1/2013 and 6/30/2017. VRE rectal swabs were obtained per protocol on waitlisted patients established in November 2014. VRE Infection was identified through labs and verified with chart review. Cox Proportional Hazards Model was used to evaluate associations between predictors and post-transplant events. Post-transplant ERCP is treated as a time-dependent variable in association with VRE infection. Competing Risk analysis was used to calculate VRE infection rates and ERCP event rates.

Results: Between 1/1/2013 and 6/30/2017, 148 patients underwent liver transplant. The mean age was 56.9 +/- 10.6, 61% were male, 30% received DCD organs, and 20% were liver-kidney transplants. The mean MELD was 29 +/- 8.4 with 43% having a MELD ≥ 31. 83 (56%) had VRE rectal swabs performed. Of those 83, 33 (40%) were colonized. VRE infection rates were 6.1%, 15.5%, and 16.9% at 1, 3, and 6 months post-transplant. In total 13 patients underwent ERCP post-transplant. DCD recipients were more likely to undergo ERCP than non-DCD recipients (HR=3.96 (1.29-12.10), p=0.02). In univariate models, patients who are female, have longer length of stay post-transplant, have a transplant MELD ≥ 31, and undergo ERCP all had significantly increased risk for VRE infection post-transplant. VRE colonization was associated with an increased risk of VRE infection, though not statistically significant (HR=2.3 (0.86-5.9), p=0.10). In stepwise selection, ERCP post-transplant (HR=6.1 (2.0-18.5), p<0.01) and MELD ≥ 31 (HR=2.8 (1.3-5.9), p<0.01 were significantly associated with an increased risk of VRE infection. Although, DCD recipients were more likely to undergo ERCP, DCD was not significantly associated with VRE infection in this cohort.

Conclusion: Patients who undergo ERCP and have MELD ≥ 31 had a significant increased risk of VRE infection even after testing for other variable inclusion. These predictors are most likely identifying with sicker patients pre-transplant and those that received a DCD organ.

CITATION INFORMATION: Aldag E., Pedersen R., Gunabushanam V., Sahajpal A., Fehrenbacher L., Kramer D. Evaluation of Risk Factors for Vancomycin Resistant Enterococcus (VRE) Infection in Adult Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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