Postoperative care in pediatric liver transplantation

Tannuri, Uenis; Tannuri, Ana Cristina Aoun

doi:10.6061/clinics/2014(sup01)08

Cited by 25 publications

(17 citation statements)

References 9 publications

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“…In this study, the high rates of bacterial infection in children hospitalized after LT were detected (54.3%, 51 out of 94) including 31.9% (30 out of 94) microbiologically documented ones. This finding is consistent with the limited reports about LT children worldwide (51.9% in Germany and 70.8% in France) . During the first weeks after transplantation, bacteria are the main infectious agents, as they tend to occur due to indwelling catheters and at or near the transplanted organ, either in the form of a superficial wound or deep space infections .…”

Section: Discussionsupporting

confidence: 91%

Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran

Pouladfar

Jafarpour

Malek-Hosseini

et al. 2018

Transplant Infectious Dis

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Section: Discussionsupporting

confidence: 91%

Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran

Pouladfar

Jafarpour

Malek-Hosseini

et al. 2018

Transplant Infectious Dis

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“…Our ndings are also in accordance with the limited reports worldwide regarding LT in pediatrics (51.9% in Germany and 70.8% in France). [18][19][20][21][22]. In a 23-year, retrospective single-center study conducted by Kukreti et al, 49 incidents of microbiologically documented infection were observed among 145 pediatrics (34%) in post LT, which 79% had bacterial infections only during their stay in the pediatric ICU.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Infections after Pediatric Liver Transplantation

Shafiekhani

Shahriarirad

parandvar

et al. 2020

Preprint

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Background: Liver transplantation (LT) is the only curative therapy for acute and chronic end-stage liver disease in pediatrics. Nevertheless, bacterial infection post-transplant account for one of the most significant causes of mortality which requires attention, along with appropriate antibacterial treatment. Therefor this study was designed to provide a multifaceted overview of bacterial infections during a one-year experience in the biggest pediatrics LT center in Iran.Methods: In this retrospective cohort study, records from all liver transplant pediatrics in Abu-Ali Sina hospital, Shiraz, Fars, Iran from April 2019 to February 2020 were assessed. Demographic, laboratory, and clinical data were extracted along with the administered therapeutic approach for the patient.Results: an incidence of 67.9% bacterial infection rate was observed, in which more than 64.06% of isolated pathogens were Gram-negative and 35.93% were gram-positive. The most isolated pathogens were E. coli sp. and pseudomonas sp. for gram negative, and enterococci and staph sp. for gram positive. Our study demonstrated that Intra-abdominal Surgical Site Infections (24.24%) was the most common site of infections in post LT pediatrics. According to the results of the sensitivity-resistance pattern of isolated pathogens, 24.39% of isolated gram-negative bacteria were Extensively drug resistant (XDR). Also, 30.43% of gram-positive bacteria were Vancomycin-resistant enterococci (VRE) and 8.69% of them were methicillin-resistant staphylococcus aureus (MRSA). Furthermore, multivariate regression analysis showed that the only risk factor for bacterial infections after LT is the length of stay in the ICU. The mortality rate in our study was 22%, which was significantly higher among the infection group (P = 0.008). Also, it was found that patients receiving colistin had a significantly shorter in length of stay in the ICU and hospital than those who did not receive colistin. There is no any significant difference between piperacillin-tazobactm versus meropenem as empirical treatment regarding clinical outcomes.Conclusion: a high rate of bacterial infection was detected among hospitalized pediatrics in the early period after LT. High antibacterial resistance of bacteria isolated from LT pediatrics is alarming. Furthermore, Replacement of piperacillin-tazobactam instead of carbapenems in empirical treatment should be considered.

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“…26 HAT is associated with increased mortality, re-intervention, re-transplantation, and reduced long-term graft survival. 10,11,17,24,25 Although specific types of postoperative thrombotic complications were not defined in the UNOS database, the vast majority of these events in both adults and children are most likely related to HAT. 15,[17][18][19][20] In the pediatric population, HAT is the most frequent postoperative vascular complication with an incidence of up to 26%.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,17,24,25 Although specific types of postoperative thrombotic complications were not defined in the UNOS database, the vast majority of these events in both adults and children are most likely related to HAT. 15,[17][18][19][20] In the pediatric population, HAT is the most frequent postoperative vascular complication with an incidence of up to 26%. [21][22][23][24] The cause of this predisposition to perioperative thromboses is likely related not only to changes in their coagulation profile but also to the difficulty in performing surgical anastomoses in very small children.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation

Bezinover

Deacutis

Dalal

et al. 2019

HPB

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Background: This retrospective UNOS database evaluation analyzes the prevalence of preoperative portal vein thromboses (PVT), and postoperative thromboses leading to graft failure in pediatric patients undergoing liver transplantation (LT). Methods: The evaluation was performed in three age groups: I (0-5), II (6-11), III (12-18) years old. Factors predictive of pre-and postoperative thromboses were analyzed. Results: Between 2000 and 2015, 8982 pediatric LT were performed in the US. Of those, 390 patients had preoperative PVT (4.3%), and 396 (4.4%) had postoperative thromboses. The prevalence of both types of thromboses was less in Group III than in the other two groups (3.20% vs 4.65%, p = 0.007 and 1.73% vs. 5.13%, p < 0.001, respectively). The prevalence of postoperative thromboses was significantly higher in Group I than in the other two groups (5.49% vs. 2.51%, p < 0.001). Preoperative PVT was independently associated with postoperative thromboses (OR = 1.7, p = 0.02). Children less than 5 years of age were more likely to develop postoperative thromboses leading to graft failure (OR = 2.9, p < 0.001). Conclusion: Younger children undergoing LT are prone to pre-and postoperative thrombotic complications. Preoperative PVT at the time of transplantation was independently associated with postoperative thromboses. Perioperative antithrombotic therapy should be considered in pediatric patients undergoing LT.

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Postoperative care in pediatric liver transplantation

Cited by 25 publications

References 9 publications

Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran

Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran

Bacterial Infections after Pediatric Liver Transplantation

Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation

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