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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Infections Within the First Month After Pediatric Lung Transplantation: Epidemiology and Impact on Outcomes
Chinyere Onyearugbulem1,2,3, Jorge Coss-Bu1,2,3, Maria C Gazzaneo1,2,3,4
1Department of Pediatrics, Texas Children's Hospital, Houston, Texas.
Insights
Infections are common in pediatric lung transplant recipients within 30 days post-transplant. Late viral infections significantly impact 3-year survival, highlighting the need for targeted interventions.
Area of Science:
- Pediatric critical care medicine
- Transplant infectious diseases
- Pulmonary medicine
Background:
- Infection is the primary cause of mortality in the first year post-lung transplantation, impacting survival rates compared to other solid organ transplants.
- Early post-transplant infections can negatively affect both short-term and long-term outcomes in pediatric lung transplant recipients (LTRs).
Purpose of the Study:
- To investigate the epidemiological characteristics of infections occurring within the first 30 days after pediatric lung transplantation.
- To assess the association between early post-transplant infections and mortality outcomes in pediatric LTRs.
Main Methods:
- A retrospective review was conducted on pediatric LTRs from January 2009 to March 2016.
- Infections within 30 days post-transplantation were analyzed, with the period divided into early (0-7 days) and late (8-30 days) phases.
- Kaplan-Meier analysis and multivariable analysis were used to evaluate survival outcomes.
Main Results:
- Of 98 pediatric LTRs, 51 infection episodes were recorded.
- Cystic fibrosis (CF) patients had more early bacterial infections, while non-CF patients experienced more late viral infections.
- Infection post-transplantation was linked to poorer survival (P=.007); late viral infections specifically correlated with 3-year mortality (P=.02).
Conclusions:
- Infections are frequent in pediatric LTRs within 30 days, even with antimicrobial prophylaxis.
- Late viral infections are significantly associated with 3-year mortality, suggesting a critical role in lung graft function.
- Understanding early infection patterns is crucial for optimizing post-operative management and reducing the impact of infections on pediatric lung transplant outcomes.
Background:
Despite successes in lung transplantation, with infection as the leading cause of death in the first year following lung transplantation, there remains a lag in survival compared with other solid organ transplants. Infections that occur early after transplantation may impact short- and long-term outcomes in pediatric lung transplant recipients (LTRs).
Methods:
We performed a retrospective review of pediatric LTRs at a large quaternary-care hospital from January 2009 to March 2016 to evaluate both epidemiologic features of infection in the first 30 days post-transplantation and mortality outcomes. The 30 days were divided into early (0-7 days) and late (8-30 days) periods.
Results:
Among the 98 LTRs, there were 51 episodes of infections. Cystic fibrosis (CF) was associated with early bacterial infections (P = .004) while non-CF was associated with late viral (P = .02) infections. Infection after transplantation was associated with worse survival by Kaplan-Meier analysis (P value log rank test = .007). Viral infection in the late period was significantly associated with 3-year mortality after multivariable analysis (P = .02).
Conclusions:
Infections in pediatric LTRs were frequent in the first 30 days after transplant, despite perioperative antimicrobial coverage. The association of 3-year mortality with late viral infections suggests a possible important role in post-transplant lung physiology and graft function. Understanding the epidemiology of early post-lung transplant infections can help guide post-operative management and interventions to reduce their incidence and the early- and long-term impact in this population.
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