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Association Between Mortality and Detection of Respiratory Viruses in Children During the Peri-Liver Transplant
Juan Sebastian Calderón Cárdenas1, Juan David Bustos2, Martha I Álvarez-Olmos1
1From the Section of Pediatric Infectious Diseases, Fundación Cardioinfantil-Instituto de Cardiología, Universidad del Bosque, Bogotá, Colombia.
Insights
Viral detection in children undergoing liver transplants increases mortality and surgical complication risks. Early identification and management are crucial for improving outcomes in pediatric liver transplant recipients.
Area of Science:
- Pediatric Hepatology
- Transplant Infectious Diseases
- Virology
Background:
- Liver transplantation in children is complex, with potential for significant morbidity and mortality.
- Viral infections pose a substantial threat during the peri-transplant period, impacting graft survival and patient outcomes.
Purpose of the Study:
- To assess the impact of viral detection on disease burden, complications, and mortality in pediatric liver transplant recipients.
- To identify specific viruses associated with adverse outcomes in the peri-transplant period.
Main Methods:
- Retrospective cohort study of 169 children undergoing liver transplantation (Jan 2020-Dec 2023).
- Multiplex polymerase chain reaction (PCR) testing performed 7 days pre- to 14 days post-transplant.
- Analysis of associations between viral detection and mortality/surgical complications.
Main Results:
- Viral detection occurred in 38.5% of children, most commonly rhinovirus/enterovirus, adenovirus, and parainfluenza.
- Viral detection was linked to significantly higher odds of mortality (aOR 2.56) and surgical complications (aOR 2.18).
- Bacterial coinfection further elevated mortality risk in children with viral detection (aOR 2.64).
Conclusions:
- Peri-transplant viral detection in pediatric liver transplant recipients is associated with increased mortality and postoperative surgical complications.
- Respiratory viruses are significant contributors to adverse outcomes in this vulnerable population.
- Findings underscore the importance of vigilant viral surveillance and management in pediatric liver transplantation.
Background:
To evaluate the disease burden, risk of complications and mortality in children with viral detection during the peri-liver transplant period.
Methods:
A retrospective cohort study was conducted between January 2020 and December 2023 at a tertiary university hospital. Children who underwent multiplex polymerase chain reaction testing from 7 days before to 14 days after liver transplantation were included. The primary outcome was the association between peri-transplant viral detection and mortality. Data were obtained from the hospital's medical records and laboratory databases.
Results:
A total of 169 children with a median age of 0.9 (interquartile range, 0.5-7.1) years were included. The primary indication for liver transplantation was biliary atresia with liver cirrhosis (47.3%). Living-donor transplantation was performed in 89.9% of cases. Viral detection occurred in 38.5% (65/169) of children, with 57% detected pre-transplant. The most frequently identified viruses were rhinovirus/enterovirus, adenovirus and parainfluenza. Children with viral detection had higher odds of mortality [20% vs. 8.7%; adjusted odds ratio (aOR), 2.56 (95% confidence interval [CI], 1.02-6.42); P = 0.03] and surgical complications [aOR, 2.18 (95% CI, 1.12-4.27); P = 0.02], regardless of the transplant indication or donor type. Bacterial coinfection further increased the odds of mortality in the viral detection group [aOR, 2.64 (95% CI, 1.06-6.61); P = 0.03].
Conclusions:
In children with severe hepatocellular dysfunction undergoing liver transplantation, respiratory viral detection during the peri-transplant period was associated with an increased risk of mortality and postoperative surgical complications.
