Infection risk after paediatric liver transplantation

Abstract

Infections after liver transplantation (LT), despite prophylactic therapy, are still important causes of morbidity and mortality in children. Although underlying disease and immunosuppression along with the complexity of LT procedure are the major predispositions to infections, there still might be under recognised factors predisposing infections in paediatric LT. In this study, we retrospectively analysed the risk factors of bacterial, viral, and fungal infections after LT in a series of 167 children (median =5 yr.). Of all children, 112 (67%) experienced infections: 93 (55.7%) bacterial, 56 (33.5%) viral and 15 (9%) fungal. Multilogistic regression analysis showed that the need of immunosuppressive switch increased total, bacterial, and viral infection risk 5.3, 2.5, and 2.5 times, respectively, (p=0.001, p=0.021, and p=0,019, respectively). Re-LT increased bacterial infection risk 4.2 times (p=0.040). Viral infection risk was 10 times higher in children who had more than two re-laparotomies (p=0,002). Children who had post-LT, cytomegalovirus (CMV) infection had 5.6 times increased risk for fungal infection (p=0.035). In conclusion, infection is still an important morbidity in paediatric LT and is in close relationship with other morbidities such as surgical complications. CMV infection, itself, is an independent risk factor for fungal infection.

Epidemiology, Risk Factors and Outcome Due to Multidrug Resistant Organisms in Paediatric Liver Transplant Patients in the Era of Antimicrobial Stewardship and Screening

“…Despite the advancements in surgical techniques, immunosuppressive therapies, and improved post-operative care, bacterial infections remain the most important complication amongst paediatric liver transplant recipients (LTR) [1][2][3][4][5][6]. The overall incidence of bacterial infections varies from centre to centre, with studies reporting an incidence of 25 to 68% [1][2][3][4]7,8].…”

An Overview of Paediatric Liver Transplant in Hospital Selayang: 2002 to 2015

“…In some centres, infections are the most common cause of mortality after LT. Underlying disease, malnutrition, immunosuppression and complexity of LT procedure are the major predispositions to infections [9]. The infection rate in our centre was as high as 68% and it was the main cause of mortality.…”

“…Studies have shown up to 80% of patients experience at least one infection episode within the first year of LT [9]. And some reported the rate of infection following liver transplantation is between 47% and 80%, with a mean of one to 2.5 episodes of infections per patient [8].…”

Epidemiology and Risk Factors for Viral Infections in Pediatric Liver Transplant Recipients and Impact on Outcome

“…A previous study from our center showed higher percentages of CMV infection (60%) for pediatric LTR on long term follow up, up to 2 years [ 5 ]. In contrast, a Turkish study reported low incidence of CMV (23.4%) and EBV (15.6%) infection, likely due to less frequent monitoring of CMV and EBV DNA [ 15 ]. It is noticeable that viral infections in adults post-LT does not impose a major burden, as it does in the pediatric population.…”