*Purpose: To elucidate the epidemiology and peri-transplant risk of CDI

*Methods: Retrospective review of adult renal transplant (RTX) recipients from 1/1/2012-12/31/2015. Primary objective was to describe incidence and risk factors associated with CDI occurring in the first 90 days after transplant. Secondary objective was to evaluate the effect on post 90 day transplant outcomes.

*Results: 982 patients qualified for inclusion; 46 with CDI in the first 90 days post-transplant (CDI-90) and 936 without. Overall rate of CDI in the total population was 4.7% at 3 months, 6.3% at 1 year, and 6.4% at 3 years. Of patients that kept their graft for at least 90 days, incidence of CDI-90 was 46/918=5% with mean time to diagnosis of 19.4±25 days. When investigating risk factors for CDI at any time after transplant, donation after circulatory death (DCD) donor relative to living donors (HR 2.5 95% CI (1.3-4.9), p=0.008) and female gender (HR 1.6 95% CI (1.0-2.7), p=0.049) were significant in a univariate analysis. Recipient age at transplant, induction and hospital length of stay at transplant did not significantly increase risk. Sensitization as measured by cPRA and total mismatches appeared to be trending, but were not significant (p=0.06 and 0.07, respectively). However, when specifically investigating risk factors for CDI in the first 90 days, non-white race for the donor (HR 1.3 95% CI (1.0-1.7), p=0.03), the use of alemtuzumab induction relative to thymoglobulin (HR 1.5 95% CI (1.1-2.0), p=0.005) and patient age at transplant (HR 1.007 95% CI (1.002-1.012), p=0.007) were significant. On Kaplan-Meier analysis, CDI-90 appeared to have an impact on patient/graft survival, however when adjusted in a multivariable model, the factor significantly associated with these outcomes was age at transplant (HR 1.03, CI 1.01-1.05, p=0.002). Others that were analyzed in a stepwise Cox proportional hazards model but were not significant at a 0.05 level included; CDI-90, donor BMI, donor age, donor race, donor gender, recipient BMI, recipient race, donor type (DBD, DCD, vs. live), CMV status, recipient sex, induction type, maintenance immunosuppression, cPRA, total mismatches, and admission LOS.

*Conclusions: Overall incidence of CDI-90 at our institution is low and most occurs in the first post-operative month. Risk factors for CDI vary based on time from transplant, with induction having effect when temporally associated with administration, and age temporally associated with the CDI event. Associations between CDI and negative graft outcomes appear to be largely driven by age. Future studies taking into consideration time from transplant are needed to further identify populations at risk and elucidate those who may benefit from prophylaxis strategies.

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