Spondylitis complicating features of a liver transplant.

R. Buzelé, V. Zarrouk, C. Francoz, F. Durand, B. Fantin

Abstract: 

Study Purpose: To define the clinical features and the therapeutic outcome of spondylitis in patients who have received liver transplantation (TH).

Methods: retrospective single-center study over a period from 2000 to 2012. All cases of spondylitis in liver transplant patients were reviewed. A non-transplanted control group (three witnesses per patient) was selected for comparative study.

Results : Of 740 patients (Pts) who received TH during the study period, 9 had a spondylitis (sex ratio M / F = 7/2, median age = 56 years). The initial liver was Originally viral C (n = 4), B (n = 2), ethyl (n = 2), autoimmune (n = 1), with associated NASH (n = 3). The median MELD score before LT was 24. Eight pts had ≥1 infection from TH 5 with ≥1 infection same germ that isolated during spondylitis. The median time to onset of spondylodiscitis after LT was 12 weeks [4-41 weeks]. We observed pain in 8 cases, fever in 4 cases. The median time to diagnosis after first symptoms was 5 weeks [1-9]. Pathogens in question were: pyogenic (n = 3, 2 S. aureus ), fungi (n = 3, 2 Aspergillus fumigatus , 1 Candida albicans ), Mycobacterium tuberculosis (n = 1), no documentation (n = 2). The diagnosis was made ​​by biopsy (n = 4), blood cultures (n = 1), surgical biopsy (n = 1), other (n = 1). The median treatment duration was 12 weeks [6-88 weeks]. Microbiological cure was achieved in 8 patients. Compared to the control group (n = 27), the mean age was lower (p <0.01), CRP and lower leukocytosis (p <0.01), the most frequently disseminated infection (p = 0.05), the most common fungal etiology (p = 0.01), the sensitivity of lower blood cultures (p = 0.02). Cure rates were similar (89% versus 79%).

Conclusion : Nine cases of spondylitis in liver transplant patients were identified. This was usually disseminated infections with biomarkers of inflammation lower than in non-transplant patients. The origin was often fungal. The outcome was favorable in 89% in the price sometimes very prolonged treatments.

2014

Full conference title: 

Réunion Interdisciplinaire de Chimiothérapie Anti Infectieuse