Risk factors for infection after pediatric lung transplantation

Area of Science:

• Pediatric transplantation
• Infectious diseases
• Critical care medicine

Background:

• Infection is the primary cause of mortality within the first year after pediatric lung transplantation.
• Early post-operative sepsis is often under-recognized and under-reported in pediatric lung transplant recipients (LTRs).
• Limited data exist on the specific risk factors contributing to early infections in this vulnerable population.

Purpose of the Study:

• To determine the incidence of infection and sepsis in the early post-operative period for pediatric LTRs.
• To identify significant risk factors associated with early post-operative infection in pediatric LTRs.

Main Methods:

• Retrospective review of medical records for pediatric LTRs from January 2009 to March 2016.
• Analysis of microbiology results from post-transplant days 0-7.
• Sepsis defined using the 2005 International Pediatric Consensus Conference criteria.
• Evaluation of risk factors including donor/recipient infection history, multi-drug resistant (MDR) infection history, nutritional status, and surgical times.

Main Results:

• Out of 98 pediatric LTRs, 22 (22%) experienced post-operative infections.
• Prolonged donor ischemic time (≥7 hours), cardiopulmonary bypass (CPB) time (≥340 minutes), history of MDR infection, and cystic fibrosis diagnosis were associated with infection.
• Multivariable regression analysis identified prolonged donor ischemic time as the only significant independent risk factor (OR 4.4, 95% CI: 1.34-14.48).

Conclusions:

• Prolonged donor ischemic time is a significant risk factor for early post-operative infection in pediatric lung transplant recipients.
• Further research is warranted to explore strategies for reducing donor ischemic time to mitigate post-transplant morbidity.