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Published on: November 7, 2020
Postoperative infectious complications in paediatric liver transplantation: a study of 48 transplants
J C Bouchut1, D Stamm, O Boillot
1Paediatric Intensive Care Unit, Edouard Herriot Hospital, Lyon, France.
Insights
Infections after paediatric liver transplants are common, with bacterial bloodstream and abdominal infections predominating. Low body weight in recipients is the primary risk factor for developing these postoperative complications.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Infectious Diseases
Background:
- Postoperative infectious complications are a significant concern following pediatric liver transplantation.
- Understanding infection epidemiology and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To characterize the epidemiology of infections in pediatric liver transplant recipients.
- To identify risk factors associated with early postoperative infectious complications.
Main Methods:
- Retrospective study of 48 liver transplants in 46 patients at a single university center.
- Analysis of infections occurring within the first postoperative month or during the pediatric intensive care unit (PICU) stay.
- Stratified analysis to determine independent risk factors for infection.
Main Results:
- Sixty-three infections were documented in 32 patients (1.36 infections/patient), predominantly bacterial (47/63).
- Common infection sites included the bloodstream (36.5%) and abdomen (30%). Gram-positive bacteria were most frequent (78%).
- Initial risk factors identified included young age, low body weight, specific biliary atresia type, intraoperative transfusions, prolonged mechanical ventilation, and extended PICU stay. Low body weight was the main risk factor after stratified analysis.
Conclusions:
- Low body weight is a critical risk factor for postoperative infections in pediatric liver transplant recipients.
- Targeted surveillance and preventative strategies for low-weight infants may reduce infectious complications.
- Further research into specific pathogen profiles and tailored interventions is warranted.
Abstract:
We studied, retrospectively, postoperative infectious complications following paediatric liver transplantation at a single university centre. The objectives were to characterize the epidemiology of infection and to determine the associated risk factors during the early postoperative period, either the first postoperative month or the entire duration of paediatric intensive care unit (PICU) stay. Forty-eight liver transplants were performed on 46 patients. Sixty-three infections occurred in 32 patients who underwent 34 liver transplantations (1.36 infection/patient); 47 were bacterial, 6 fungal and 10 viral. The most common sites of infection were bloodstream (36.5%) and abdomen (30%). Gram-positive bacteria (78%) predominated over gram-negative bacteria (22%). Initial analysis revealed infection risk factors to be age <1 year, body weight <10 kg, extrahepatic biliary atresia, intraoperative transfusion > 160 ml x kg(-1), mechanical ventilation > 8 days and PICU stay > 19 days. After stratified analysis, the main risk factor for infection was low body weight of the recipient.
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