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Patterns of infection after pediatric liver transplantation
1Department of Medicine, University of Chicago Hospitals, IL.
Insights
Pediatric liver transplant recipients frequently experience infections, primarily bacterial, within the first two weeks post-transplant. Understanding these infection patterns is crucial for improving patient care and outcomes.
Area of Science:
- Pediatric transplantation
- Infectious diseases
- Hepatology
Background:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for children with end-stage liver disease.
- Post-transplant infections represent a significant cause of morbidity and mortality in pediatric OLT recipients.
- Characterizing infection patterns is essential for optimizing immunosuppression and prophylactic strategies.
Purpose of the Study:
- To define the incidence, timing, and types of infections following pediatric OLT.
- To identify common pathogens and primary infection sites.
- To explore associations between infection patterns and clinical factors.
Main Methods:
- Retrospective analysis of an inception cohort of 36 pediatric OLT recipients.
- Data collected on all infections occurring after transplantation.
- Identification of causative pathogens and infection sites.
Main Results:
- 72% of children experienced at least one infection; 4 deaths were infection-related.
- Infections were most common within the first two weeks post-transplant.
- Bacterial infections predominated (52 cases), followed by viral (16) and fungal (11); aerobic gram-negative bacilli and enterococci were common bacterial isolates. Cytomegalovirus was the most frequent viral pathogen.
- Antilymphocyte antibody use was associated with a higher infection rate (2.9 vs 1.0 infections/transplant).
- Fungal infections correlated with antibiotic therapy and abdominal complications.
Conclusions:
- Distinct infection patterns emerge after pediatric OLT.
- Knowledge of these patterns aids in early diagnosis and targeted treatment.
- Improved understanding can lead to better management and outcomes for pediatric liver transplant recipients.
Objective:
To characterize the patterns of infection that occur after orthotopic liver transplantation in children.
Design:
Inception cohort, retrospective.
Setting:
Referral center for liver transplantation, university hospital.
Patients:
Thirty-six consecutive children who underwent orthotopic liver transplantation and who survived for at least 48 hours after transplantation.
Interventions:
None.
Measurements And Results:
Twenty-six (72%) of the children had at least one infection, and infection caused four deaths. More infections occurred when prophylactic antilymphocyte antibodies were given than when they were not given (2.9 vs 1.0 infections per transplant). The risk of infection was greatest during the first 2 weeks after orthotopic liver transplantation. Most infections were caused by bacteria (52 cases), followed by viruses (16 cases) and fungi (11 cases). Bacteria were the most common pathogens during all periods, except the third and fourth weeks, when viruses predominated. The most common primary sites of bacterial infection were abdomen (15 cases), bloodstream (15 cases), and surgical wound (10 cases); the most frequent isolates were aerobic gram-negative bacilli (48% of isolates) and enterococci (19%). Cytomegalovirus was the most common viral pathogen (seven cases), and Candida albicans caused all fungal infections. Fungal infections were significantly associated with systemic antibiotic therapy and abdominal complications.
Conclusions:
Characteristic patterns of infection occur after pediatric orthotopic liver transplantation, and knowledge of these patterns is likely to result in improved care for transplant recipients.