IMPACT OF CLOSTRIDIOIDES DIFFICILE INFECTION ON OUTCOMES IN LIVER TRANSPLANT RECIPIENTS: A COMPREHENSIVE META-ANALYSIS
Recommended Citation
Chaudhary A, Shahzil M, Hasan F, Muhammad A, Jomaa D, Ejaz A, Faisal MS, Dababneh Y, Patel Rodrigues P, Khaqan MA, Jafri S. IMPACT OF CLOSTRIDIOIDES DIFFICILE INFECTION ON OUTCOMES IN LIVER TRANSPLANT RECIPIENTS: A COMPREHENSIVE META-ANALYSIS. Hepatology 2024; 80:S1072-S1073.
Document Type
Conference Proceeding
Publication Date
10-9-2024
Publication Title
Hepatology
Abstract
Background: Clostridioides difficile (C. difficile) is a Gram-positive, anaerobic, spore-producing bacillus common in the human gastrointestinal tract. Gastrointestinal dysbiosis, often due to antibiotic use, can lead to severe CDI, a frequent healthcare-associated complication, especially in liver transplant (LT) recipients. LT recipients are at higher risk due to compromised immune defenses and other factors. This meta-analysis aims to understand CDI mortality rates, hospital length of stay, MELD scores, PPI use, and CDI recurrence in LT recipients. Methods: This meta-analysis adhered to Cochrane guidelines and PRISMA standards. A comprehensive search was conducted across PubMed, MEDLINE, Embase, Scopus, and CENTRAL databases until October 2023. Inclusion criteria targeted RCTs and observational studies with LT patients. Data extraction followed PICOS criteria using Excel. Statistical analyses utilized RevMan with a random-effects model, considering results significant at p < 0.05. Risk of bias was assessed with the Newcastle- Ottawa Scale, and GRADE considerations determined evidence certainty. Results: Of 2144 screened studies, 10 studies with 1,216,500 LT patients were included: 39,309 with CDI and 1,177,191 without CDI. Primary outcomes assessed were mortality and hospital length of stay (LOS). Mortality showed no significant difference (RR: 1.34; 95% CI: 0.38, 4.72). LOS was significantly longer in CDI patients (mean difference: 6.00 days; 95% CI: 2.83, 9.17). Secondary outcomes included PPI use and MELD scores. PPI use showed no significant association with CDI risk (RR: 2.18; 95% CI: 0.29, 16.27). MELD scores were significantly higher in CDI patients (mean difference: 2.77; 95% CI: 1.34, 4.20). CDI recurrence rate was 14.7%. Risk of bias was assessed with the Newcastle-Ottawa Scale, and evidence quality was evaluated using GRADE, showing moderate quality for most outcomes due to confounding bias and non-randomization. Conclusion: This meta-analysis shows that CDI significantly impacts morbidity and length of hospital stay in liver transplant recipients but does not affect mortality. Patients with CDI had longer hospital stays and higher preoperative MELD scores, highlighting the importance of vigilant postoperative monitoring. Further research is needed to identify specific risk factors and optimize patient outcomes through targeted interventions and preventive measures.
Volume
80
First Page
S1072
Last Page
S1073
