Risk factors for early invasive fungal infections in paediatric liver transplant recipients

Area of Science:

• Pediatric transplantation immunology
• Infectious diseases
• Hepatology

Background:

• Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality following liver transplantation.
• Data on IFIs in pediatric liver transplant recipients are limited, particularly concerning early post-transplant outcomes.

Purpose of the Study:

• To determine the incidence and identify risk factors for IFIs in pediatric liver transplant recipients within the first three months post-transplantation.
• To develop a predictive model for identifying high-risk pediatric patients for IFIs.

Main Methods:

• Retrospective analysis of pediatric liver transplant recipients from 2004 to 2014.
• Stepwise logistic regression was employed to identify independent risk factors for IFIs.
• A predictive model was formulated using key clinical parameters.

Main Results:

• Ten IFIs were observed in 81 recipients (12.3%), all within the first month post-transplantation.
• Candida species, including non-albicans Candida, were the primary causative agents.
• Significant risk factors identified included multiple blood transfusions, prolonged IV catheter use, extended IV antibiotic treatment, surgical complications, pulse steroid therapy, and living donor liver transplantation.

Conclusions:

• IFIs represent a substantial early complication in pediatric liver transplant recipients, predominantly occurring within the first month.
• A predictive model incorporating living donor transplantation and duration of IV antibiotic treatment effectively identifies high-risk patients (AUC 0.918).
• Further research is warranted to evaluate targeted antifungal prophylaxis strategies for high-risk pediatric liver transplant recipients.