Infection in Solid-Organ Transplant Recipients

To the Editor: In his review of infections in recipients of solid-organ transplants, Fishman (Dec. 20 issue)1 discusses Clostridium difficile diarrhea in the immediate post-transplantation period. Although this infection has been reported previously in liver-transplant recipients,2 there is mounting evidence that gastric acid suppression may be implicated in this infection both in the community and in hospitalized patients,3,4 including patients with cirrhosis.5 In many institutions that perform transplantation, it is standard practice to prescribe proton-pump inhibitors in the immediate post-transplantation period in order to provide protection against stress ulceration and bleeding in the intensive care setting and subsequently as . . .