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

Objective: The primary outcomes are to look at VRE infection rate post-transplant and risk factors associated with VRE infection. The secondary outcome is to determine baseline VRE colonization rates in our patient population prior to transplant.

Methods: Adult patients undergoing liver transplantation between 1/1/2013 and 6/30/2016 were included. VRE rectal swabs were obtained per protocol on waitlisted liver transplant patients established in November 2014. VRE infection was identified through labs and verified with chart review. Cox Proportional Hazards Model was used to identify predictors of VRE infection post-transplant. Competing Risk analysis was used to calculate VRE infection rates.

Results: Between 1/1/2013 and 6/30/2016, 127 patients underwent liver transplant. The mean age was 57.3 +/- 9.4, 64% were male, 32% received DCD organs, and 21% were liver-kidney transplants. The mean MELD was 29 +/- 8.5 with 46% having a MELD ≥ 31. 62 (49%) had VRE rectal swabs performed. Of those 62 with a swab, 23 (37%) were colonized. VRE infection rates were 6.3%, 15.7%, and 17.4% at 1, 3, and 6 months post-transplant. Female gender (Hazard Ratio (HR)=2.37 (1.06-5.28), p=0.04), MELD ≥ 31 (HR=2.58 (1.10-6.02), p=0.03), longer post-transplant length of stay (LOS) (HR per 7 day increase=1.10 (1.02-1.19),p=0.01), and having been exposed to meropenem prior to transplant (HR=3.45 (1.28-9.29), p=0.01) were statistically significantly associated with increased risk of VRE infection in univariate analysis. VRE colonization was not significantly associated with VRE Infection (HR=1.27 (0.40-4.02), p=0.68).

Conclusion: VRE colonization was not statistically significantly associated with VRE infection post-transplant in this patient group. However, low volume of patients where colonization can be determined could be a limiting factor. Gender, MELD, longer LOS, and meropenem were associated with VRE infection in univariate models and LOS and meropenem were independent predictors. These predictors are most likely identifying sicker patients and their increased susceptibility to VRE infection.

CITATION INFORMATION: Aldag E, Fouth G, Pedersen R, Fehrenbacher L, Sahajpal A, Gunabushanam V, Kramer D. Evaluation of Vancomycin Resistant Enterococcus (VRE) Colonization and Infection Rate in Adult Liver Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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