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Risk factors for fungal infection in paediatric liver transplant recipients

Anita Verma1, Jim J Wade, Paul Cheeseman

  • 1Health Protection Agency London, Department of Medical Microbiology, King's College Hospital, London, UK. anita.verma@kingsch.nhs.uk

Pediatric Transplantation
|March 25, 2005
PubMed

Insights

Fungal infections (FI) affect 40.5% of children after liver transplantation (LT), with Candida albicans being the most common cause. Key risk factors include pre-LT fungal colonization and post-LT bacterial or Epstein-Barr virus infections.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Transplantation Medicine

Background:

  • Fungal infections (FI) pose a significant, potentially fatal risk in pediatric liver transplantation (LT).
  • Limited published data exists on FI incidence and risk factors in pediatric LT recipients.

Purpose of the Study:

  • To determine the incidence of fungal infections in children undergoing LT.
  • To identify pre-, peri-, and post-LT risk factors associated with fungal infections in this population.

Main Methods:

  • Retrospective review of 79 pediatric LT cases (1997-1998).
  • Assessment of 68 pre-, peri-, and post-LT variables using univariate and multivariate analyses.
  • Analysis of fungal species and patient outcomes, including mortality and treatment response.

Main Results:

  • Fungal infection (FI) occurred in 40.5% of children within one year post-LT, with a median onset of 42 days.
  • Candida species, particularly Candida albicans (66%), were the primary cause of FI.
  • Independent risk factors for FI included pre-LT fungal colonization, pre-LT pyrexia, post-LT bacterial infection, Epstein-Barr virus (EBV) infection, and tacrolimus administration.

Conclusions:

  • Fungal infections are a common complication in pediatric liver transplant recipients.
  • Identifying specific risk factors like pre-existing colonization and post-transplant infections is crucial.
  • These findings can inform the development of targeted prophylaxis and preemptive therapy strategies to reduce FI incidence and improve outcomes.

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