Liver transplant candidates, especially those with cirrhosis are more prone to infections, which may be precipitated by semi-invasive procedures like colonoscopy. Limited data exist on infection rates post-colonoscopy and risk factors in this population. This study aimed to determine the incidence of post-colonoscopy infections and identify associated risk factors in patients awaiting liver transplantation.

A retrospective single-centre cohort study included 141 adult liver transplant candidates who underwent screening colonoscopy at a Belgian tertiary hospital (2019-2023). Inclusion required ≥24h post-procedural observation. Infection was defined as fever ≥38°C, leucocytosis (>12,000/μL), need for antibiotics or bacteraemia within 72 hours. Data on demographics, liver disease severity (MELD/Child-Pugh), comorbidities and procedural characteristics such as bowel preparation adequacy, sedation type, polypectomy were analysed. Both univariate, as well as multivariate backward logistic regression analysis was performed to identify risk factors for infections.

The overall infection rate was 6.4% (9/141), rising to 8.9% (9/101) in cirrhotic patients. Documented infections included bacteraemia, spontaneous bacterial peritonitis, and pneumonia. In univariate analysis significant risk factors were higher Child-Pugh score ≥ 9 (p = 0.04), ascites grade ≥2 (77.8% vs. 36.4%; p = 0.028), and diverticulosis (55.6% vs. 18.2%; p = 0.018). In multivariate analysis MELD score (p = 0.032), Child Pugh ≥9 (p = 0.01), INR (p = 0.024), ascites grade ≥2 (p = 0.068) and diverticulosis (p = 0.027) were independent risk factors for infections. Inadequate bowel preparation occurred in 29.1% but was not associated with infection. No significant associations were found for antibiotic/immunosuppressive use, polypectomy, or sedation type and risk for infection.

Liver transplant candidates, particularly those with advanced cirrhosis (higher MELD score and Child-Pugh ≥9), increased INR, ascites grade ≥2 or diverticulosis, face substantial infection risk (6.4-8.9%) after screening colonoscopy. Heightened clinical vigilance and optimized preventive strategies are warranted in this high-risk population.