*Purpose: Antibiotic prophylaxis for enteric pathogens is recommended before liver transplantation (LT). Perioperative screening protocols and antimicrobials vary between institutions. Some institutions that do not routinely provide perioperative prophylaxis for vancomycin-resistant Enterococcus (VRE) have reported high rates of post-LT VRE infection. Our institution routinely screens for VRE colonization before LT. Colonized individuals receive daptomycin perioperative prophylaxis (DPP) in addition to standard prophylaxis. We sought to determine the incidence and outcomes of VRE infections in VRE-colonized patients within 90 days of LT at our institution.

*Methods: We performed a retrospective chart review of LT recipients aged ≥ 18 years between 2013-2017 to identify VRE-colonized (determined via peri-rectal swab culture) LT recipients and whether they received DPP. We collected demographic and clinical characteristics, particularly risk factors for VRE infection including: type of surgical anastomosis, post-operative hemorrhage, re-operation, dialysis, and prolonged intensive care unit stay. Infections were defined by CDC criteria. Outcomes measured included VRE-related infection and mortality within 90 days of LT.

*Results: There were 18 VRE-colonized patients who received DPP. The median MELD score at the time of transplant was 37 [12-44]. The median Charlson Comorbidity Index score was 6 [3-9]. Seventeen of 18 patients (94.4%) were primary LT. All but 2 patients received basiliximab induction therapy. The majority (88.9%) underwent duct-to-duct biliary reconstruction. One (5.6%) developed biliary leak, and 6 (33.3%) required re-operation within 90 days of LT. Thirteen patients (72.2%) required postoperative dialysis. The median ICU length of stay was 8 days [2-67] post-LT. None developed VRE infection and 1 (5.6%) had asymptomatic VRE bacteriuria. One VRE-colonized LT recipient who did not receive DPP developed post-operative hemorrhage requiring re-operation, VRE bacteremia, and died within 90 days of LT.

*Conclusions: At our institution, known VRE-colonized individuals who underwent LT and received DPP did not develop VRE-related infections in the early post-LT period despite having significant risk factors for VRE infection. Our experience illustrates the importance of pre-LT VRE screening and appropriate prophylaxis in reducing VRE infections in the early post-transplant period.

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