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Published on: July 1, 2012
Invasive pneumococcal infections in pediatric liver-small bowel-pancreas transplant recipients
Hanh D Vo1, Diana F Florescu2,3, Cindy R Brown2
1Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.
Insights
Children who receive liver, spleen, and pancreas transplants (LSBPTx) face a high risk of invasive pneumococcal infections (IPI). Despite vaccination and prophylaxis, IPI can be fatal, highlighting the need for careful monitoring and potential revaccination.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Immunology
Background:
- Splenectomy in pediatric liver, spleen, and pancreas transplant (LSBPTx) recipients increases susceptibility to invasive pneumococcal infections (IPI).
- Understanding the clinical characteristics and outcomes of IPI in this vulnerable population is crucial for improving patient management.
Purpose of the Study:
- To describe the clinical features and outcomes of invasive pneumococcal infections (IPI) in children who have undergone liver, spleen, and pancreas transplantation (LSBPTx).
Main Methods:
- Retrospective review of 122 pediatric LSBPTx recipients between 2008 and 2016.
- Analysis of clinical data, including infection episodes, timing, presentation, and mortality.
Main Results:
- Nine patients experienced 12 episodes of IPI, with a median age of 3.5 years at first infection.
- The overall risk for IPI was 7.4% (0.9% per year), and the mortality rate was 22%.
- Infections included bacteremia/sepsis, pneumonia, and meningitis, often occurring despite pneumococcal vaccination and penicillin prophylaxis.
Conclusions:
- Invasive pneumococcal infections pose a significant and potentially fatal risk to pediatric LSBPTx recipients, even with vaccination and prophylaxis.
- Routine monitoring of pneumococcal antibody levels and consideration for revaccination may be necessary to ensure sustained protective immunity in these patients.
Abstract:
Children undergoing LSBPTx are at increased risk of IPI due to splenectomy. We aimed to describe the clinical features and outcomes of IPI in pediatric LSBPTx recipients. Between 2008 and 2016, 122 LSBPTx children at our center were retrospectively reviewed. Nine patients had 12 episodes of IPI; the median age at first infection was 3.5 years (range: 1.5-7.1 years). The median time from transplant to first infection was 3 years (range: 0.8-5.8 years). Clinical presentation included as follows: pneumonia (n = 1), bacteremia/sepsis (n = 7), pneumonia with sepsis (n = 1), meningitis with sepsis (n = 2), pneumonia and meningitis with sepsis (n = 1). The overall risk for IPI was 7.4% or 0.9% per year. The mortality rate was 22%. Seven (78%) children had received at least one dose of PCV13, four (44%) patients had received 23-valent pneumococcal polysaccharide vaccine prior to IPI. All patients were on oral penicillin prophylaxis. In conclusion, despite partial or complete pneumococcal immunization and reported antimicrobial prophylaxis, IPI in LSBPTx children can have a fatal outcome. Routine monitoring of pneumococcal serotype antibodies to determine the timing for revaccination might be warranted to ensure protective immunity in these transplant recipients.
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