Risk factors for rejection and infection in pediatric liver transplantation

Area of Science:

• Pediatric Hepatology
• Transplant Immunology
• Infectious Diseases

Background:

• Rejection and infection are critical adverse events following pediatric liver transplantation.
• Previous analyses have not concurrently assessed the risks of rejection and infection.

Purpose of the Study:

• To conduct a concurrent risk analysis of rejection and infection after pediatric liver transplantation.
• To identify predictors for serious bacterial/fungal and viral infections, as well as rejection.

Main Methods:

• Analysis of 2291 children (<18 years) undergoing liver transplantation.
• Multivariate analysis to identify predictors of infection and rejection.

Main Results:

• Infection occurred in 52% of patients and caused more deaths (5.5%) than rejection (0.6%).
• Early rejection (<6 months) did not impact mortality or graft failure.
• Predictors for bacterial/fungal infections included recipient age, race, donor organ factors, bilirubin, anhepatic time, and immunosuppression type (cyclosporin vs. tacrolimus).
• Predictors for viral infections included donor organ variants, rejection, Epstein-Barr Virus (EBV) naivety, and transplant era.
• Rejection predictors included age, primary diagnosis, blood type mismatch, immunosuppression type, induction therapy, and era.

Conclusions:

• Infection risk significantly outweighs rejection risk in pediatric liver transplantation, with limited harm from rejection, especially in infants.
• Aggressive infection control and tailored immunosuppression strategies based on age and risk factors are crucial.
• Modifiable factors like pretransplant nutrition and donor organ selection warrant attention.