Association between gut colonization of vancomycin-resistant enterococci and liver transplant outcomes

Background: Vancomycin-resistant enterococci (VRE) colonization is common in liver transplant recipients and has been associated with worse posttransplant outcomes. Methods: We conducted a retrospective cohort study at the University of Alberta Hospital including patients who underwent a liver transplant between September 2014 and December 2017. Results: Of 343 patients, 68 (19.8%) had pretransplant VRE colonization and 27 (27/275, 9.8%) acquired VRE posttransplant, 67% were males and the median age was 56.5 years. VRE colonized patients at baseline had higher MELD scores and required longer posttransplant hospitalization. VRE colonization was associated with increased risk of early acute kidney injury (AKI) (64% vs. 52%, p =.044), clinically significant bacterial/fungal infection (29% vs. 17%, p =.012) and invasive VRE infection (5% vs. 1%, p =.017). Mortality at 2 years was 13% in VRE-colonized versus 7% in noncolonized (p =.085). On multivariate analysis, VRE colonization increased the risk of posttransplant AKI (HR 1.504, 95% CI: 1.077-2.100, p =.017) and clinically significant bacterial or fungal infection at 6 months (HR 2.038, 95% CI: 1.222–3.399, p =.006), and was associated with nonsignificant trend toward increased risk of mortality at 2 years posttransplant (HR 1.974 95% CI 0.890–4.378; p =.094). Conclusions: VRE colonization in liver transplant patients is associated with increased risk of early AKI, clinically significant infections, and a trend toward increased mortality at 2 years.