Incidence and Risk Factors of Post-Colonoscopy Infections in Liver Transplant Candidates: A Retrospective Cohort Study

Background and study aims: Liver transplant candidates, especially those with cirrhosis are more prone to infections, potentially precipitated by semi-invasive procedures like colonoscopy. Limited data exist on infection rates post-colonoscopy and risk factors in this population. We aimed to estimate the incidence of post-colonoscopy infections and explore potential associated risk factors in patients awaiting liver transplantation.

Patients and methods: This retrospective Belgian single-centre cohort study included 141 adult liver transplant candidates undergoing screening colonoscopy (2019-2023) with ≥24h post-procedural observation. Infection was defined as fever ≥38°C, leucocytosis (>12,000/μL), need for antibiotics, or bacteraemia within 72 hours. Demographic, clinical (MELD, Child-Pugh), and procedural variables were analysed. Variables with p<0.10 in univariate analysis were entered into a backward stepwise multivariable logistic regression model for hypothesis generation.

Results: The overall post-colonoscopy infection rate was 6.4% (9/141), increasing to 8.9% (9/101) among cirrhotic patients. Infections included bacteraemia, spontaneous bacterial peritonitis, and pneumonia. Univariate analysis linked higher Child-Pugh score and INR, ascites grade ≥2, and diverticulosis with infection. Multivariable analysis suggested trends for INR (p=0.051) and diverticulosis (p=0.07). No associations were found with bowel preparation adequacy, sedation type, polypectomy, or antibiotic/immunosuppressive use.

Conclusions: Liver transplant candidates, particularly those with advanced liver disease and diverticulosis, may have a substantial risk of infection following screening colonoscopy. Because all infectious events occurred in patients with cirrhosis, these preliminary findings highlight the need for larger, prospective studies that target this high risk cirrhotic subgroup to confirm risk factors and inform risk stratified management.

Keywords: liver transplantation, cirrhosis, colonoscopy, antibiotics.