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Published on: November 7, 2020
Pattern of Infection After Pediatric Liver Transplant and Its Associated Risk Factors
Soichiro Tanimura1, Soo Lin Chuah1,2, Seiichi Shimizu3
1Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Infections after pediatric liver transplants are common, with re-laparotomy and graft recipient weight ratio being key risk factors. This study highlights crucial data for managing post-transplant infections in children.
Area of Science:
- Pediatric critical care medicine
- Transplant surgery
- Infectious diseases
Background:
- Liver transplantation significantly improves survival for children with end-stage liver failure.
- Post-transplant infections pose a substantial risk to pediatric recipients' recovery.
- Accurate identification of infection sources is critical for effective management.
Purpose of the Study:
- To determine the frequency and patterns of infections in pediatric liver transplant recipients.
- To identify factors associated with positive infection cultures after liver transplantation.
- To provide clinical insights for optimizing infection management strategies.
Main Methods:
- A retrospective, single-center study was conducted in a Japanese Pediatric Intensive Care Unit (PICU).
- 152 pediatric patients who underwent liver transplantation between 2019 and 2021 were included.
- Patients were categorized into positive and negative culture groups to analyze infection indicators.
Main Results:
- 18% of pediatric liver transplant cases showed positive bacterial cultures, with a bimodal distribution of onset.
- Bacterial infections predominated (84%), followed by fungal infections (20%).
- Re-laparotomy and a higher graft recipient weight ratio (GRWR) were significantly associated with positive cultures.
Conclusions:
- Re-laparotomy and GRWR are identified as key factors linked to infection risk in pediatric liver transplant recipients.
- This research offers valuable clinical data for enhancing infection surveillance and treatment protocols.
- Understanding these factors can improve outcomes for children undergoing living donor liver transplantation.
Background:
Liver transplantation has improved survival rates in pediatric patients with end-stage liver failure. However, post-liver transplant infection remains a threat to patient recovery. This study reported the frequency and patterns of infections after liver transplantation and identified factors related to the accuracy of fever source investigation.
Method:
This is a single-center descriptive and retrospective study in the quaternary Pediatric Intensive Care Unit (PICU) in Japan. All pediatric patients who underwent liver transplantation from 2019 to 2021 were eligible. The patients were divided into two groups based on culture positivity: the positive culture group and the negative culture group.
Results:
A total of 152 pediatric patients were included in the study. The median age was 11 months, and 86% of cases underwent living donor liver transplantation. Among the 152 cases, 18% showed positive bacterial culture results. The timing of positive culture varied bimodally, with 34% occurring after postoperative day 15. Among the positive cultures, 84% were bacterial, and 20% were fungal. Factors associated with positive culture were analyzed, and as a result, re-laparotomy and a higher graft recipient weight ratio (GRWR) were identified as factors associated with infection.
Conclusions:
We reported the frequency and patterns of infections in pediatric patients undergoing living donor liver transplantation and demonstrated that factors associated with positive culture were re-laparotomy and GRWR. This study provides important clinical data for infection management after liver transplantation.
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