The Impact of Clostridium difficile Infection on Future Outcomes of Solid Organ Transplant Recipients

OBJECTIVE. Clostridium difficile infection (CDI) is common in solid organ transplant (SOT) recipients, but few studies have examined long-term outcomes. We studied the impact of CDI after SOT on mortality and transplant organ complication-related hospitalizations (TOH). METHODS. SOT recipients 18 years of age with at least 1 year of posttransplant data were analyzed using the MarketScan database for 2007-2014. Patients who died within one year of transplant were followed until death. Patients were grouped as early CDI (ie, first occurrence 90 days posttransplant), late CDI (ie, first occurrence >90 days posttransplant) and controls (ie, no CDI occurrence during follow-up). The risk of mortality or TOH after CDI was evaluated using Cox and logistic regressions, respectively. RESULTS. Overall, 96 patients had early CDI, 97 patients had late CDI, and 5,913 patients were used as controls. The risk for death was significantly higher in the early CDI group than the control group (hazard ratio [HR],1.92; 95% confidence interval [CI], 1.12-3.29; P = .018); there was no significant difference between the late CDI group and the control group (HR, 0.86; 95% CI, 0.38-1.94; P = .717). Both the early CDI group (odds ratio [OR], 2.19; 95% CI, 1.45-3.31; P < .001) and the late CDI group (OR, 4.36; 95% CI, 2.84-6.71; P < .001) had higher risk for TOH than the control group. For those patients who survived >90 days posttransplant, both the early CDI group (n = 89) and the late CDI group (n = 97) had increased risk for death or TOH during follow-up than the control group (n = 5,734). CONCLUSION. Though our study could not prove causality, both early and late CDI occurrence in SOT recipients were associated with worse future outcomes than for SOT recipients without CDI.