Clinical Features, Treatment Strategies, and Immune Profile Changes in Kidney Transplant Recipients With Clostridioides difficile Infection: A Real-World Retrospective Study
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Abstract
Background: Clostridioides difficile infection (CDI) is a major complication in kidney transplant recipients (KTRs) due to long-term immunosuppression, antibiotic exposure, and gut microbiota disruption. Evidence guiding its management remains limited. We evaluated real-world treatment strategies, including fecal microbiota transplantation (FMT), and immunological recovery in KTRs.
Methods: We retrospectively evaluated 639 adult KTRs (January 2021–May 2023) at a Chinese transplant center, identifying 24 patients with laboratory-confirmed CDI. We systematically assessed clinical characteristics, CDI severity, baseline immunosuppression, treatment modalities, clinical outcomes, and immunological parameters, including inflammatory cytokines and peripheral lymphocyte subsets.
Results: The incidence of post-transplant diarrhea was 20.7%, and CDI incidence was 3.8%. All patients received supportive therapy; targeted anti-CDI antibiotics were used infrequently. Four patients with refractory CDI (16.7%) underwent FMT without adverse events. Following therapy, patients showed significant reductions in serum IL-1β, IL-8, IFN-γ, and TNF-α levels (p < 0.05), accompanied by significant increases in CD3+ and CD3+CD8+ T-cell counts (p < 0.01). This suggests clinical improvement correlates with attenuated systemic inflammation and restored cellular immunity. Renal function and biochemical indices remained stable. During a 24- to 52-month follow-up, no CDI recurrences occurred.
Conclusion: This real-world study provides insights into CDI management in KTRs, supporting the safety and potential therapeutic value of FMT in refractory cases. Resolution was associated with cytotoxic T-cell recovery and decreased inflammatory cytokines. Prospective studies are needed to define optimal individualized treatment strategies.
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Data Availability Statement
Due to ethical restrictions and the need to protect patient privacy and confidentiality, the raw clinical data underlying this study cannot be made publicly available. The dataset is securely stored at Henan Provincial People’s Hospital. Researchers who meet the criteria for access to confidential data may request access by contacting the corresponding author.
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