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Aspergillosis in children after liver transplantation: Single center experience
Joanna Teisseyre1, Piotr Kaliciński, Małgorzata Markiewicz-Kijewska
1Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland. jteisseyre@wp.pl
Insights
Aspergillus infection in pediatric liver transplant recipients is reduced by liposomal amphotericin B prophylaxis. Early diagnosis and treatment are crucial for improving outcomes in these immunocompromised patients.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Pediatric Infectious Diseases
Background:
- Aspergillus infections pose significant risks, leading to high morbidity and mortality in immunocompromised patients, particularly after liver transplantation (LTx).
- Prophylaxis and early detection are critical for managing invasive fungal infections in pediatric transplant recipients.
Purpose of the Study:
- To evaluate the incidence and risk factors of Aspergillosis in children undergoing LTx.
- To assess the impact of antifungal prophylaxis, specifically liposomal amphotericin B, on Aspergillosis incidence and outcomes.
Main Methods:
- Retrospective review of 277 pediatric LTx cases between 1990 and 2006.
- Analysis of Aspergillosis diagnosis, timing, risk factors, treatment, and mortality.
- Comparison of incidence rates before and after the introduction of liposomal amphotericin B prophylaxis.
Main Results:
- Aspergillosis occurred in 3.6% of pediatric LTx recipients, typically within 30 days post-transplant.
- Risk factors included multiple antibiotic therapies, prolonged ICU stay, graft dysfunction, and retransplantation.
- Introduction of liposomal amphotericin B prophylaxis reduced incidence from 6.9% to 0.6% in high-risk patients.
- Mortality due to Aspergillosis was 20% despite Amphotericin B treatment.
Conclusions:
- Aspergillosis is a serious complication in pediatric liver transplant recipients, often occurring early post-transplant.
- Liposomal amphotericin B prophylaxis significantly decreases the incidence of Aspergillus infection in high-risk children.
- Prompt diagnosis and aggressive treatment with Amphotericin B are essential to reduce mortality.
Abstract:
Aspergillus infection in immunocompromised patients is associated with high morbidity and mortality. We retrospectively reviewed cases of Aspergillosis (A), in a series of 277 children who received LTx between 1990 and 2006. All children were given antifungal prophylaxis after transplantation. Aspergillosis was identified in 10 cases (3.6%) and diagnosis was confirmed when clinical symptoms were associated with identification of Aspergillus sp. or detection of galactomannan antigen. Incidence of Aspergillosis considerably decreased from 6.9% to 0.6% when liposomal amphotericin B was introduced as prophylaxis in high-risk patients. Mean time since LTx to Aspergillosis was 14.5 days. Histologically, Aspergillosis was diagnosed in two cases. Galactomannan antigen was present in two recipients. Aspergillus infection occurs usually within first 30 days after transplantation as a result of a combination of several risk factors. Following risk factors were observed: multiple antibiotic therapy, prolonged intensive care unit stay, poor graft function, retransplantation, relaparotomies, co-infection. Amphotericin B was administered in all cases. Two patients (20%) died because of Aspergillosis Liposomal Amphotericin B prophylaxis in high-risk children decreases the incidence of Aspergillus infection. High index of suspicion and early diagnosis followed by intensive treatment with amphotericin B facilitates achieving mortality rate lower than presented in other reports.
