Incidence and Risk Factors of Fungal Infections Within 3 Months Following Pediatric Liver Transplantation

Invasive fungal infection (IFI) remains problematic following liver transplantation (LT). Routine antifungal prophylaxis is not recommended due to a lack of consensus guidelines. This study aimed to evaluate the incidence of IFI and its associated factors among pediatric LT recipients who did not receive systemic antifungal prophylaxis during the early post-transplant period.

We conducted a single-center retrospective study of children who underwent LT between January 2010 and December 2019. Data on clinical characteristics, treatment, and outcomes within 3 months following LT were collected. IFI was defined according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group consensus with slight modifications for intraabdominal fungal infections. Potential risk factors for developing IFI and IFI-related deaths were analyzed.

Of the 136 patients, 42 (31%) developed 43 episodes of IFI. The median time from LT to IFI occurrence was 7.5 days (IQR: 4, 16). Among 41 fungal isolates, Candida albicans was the most common fungal infection (56%), followed by C. tropicalis (39%). The most common site was the intraabdominal (78%). Relaparotomy (OR 4.89, 95% CI: 1.8, 13.27; p = 0.002) and postoperative bacterial infections (OR 2.97, 95% CI: 1.11, 7.93; p = 0.03) were significant independent predictors of IFI. Two patients (5%) died with active IFI.

IFI occurred in nearly one-third of LT recipients who did not receive antifungal prophylaxis during the early posttransplant period. Relaparotomy and postoperative bacterial infections were significantly associated with IFI development. These findings underscore the need for careful identification and monitoring of high-risk patients.