High Burden of Invasive Fungal Infection in Korean Pediatric Liver Transplant Recipients: A Single-Center...

The incidence of invasive fungal infection (IFI) in pediatric liver transplant (LT) recipients in Korea has not been characterized; consequently, antifungal prophylaxis is not covered by the national health insurance. We aimed to determine the incidence and epidemiology of IFI.

We conducted a single-center, retrospective study of children (age ≤19 years) who underwent LT at Severance Children's Hospital, Republic of Korea (2012-2023). IFI was defined as fungal isolation from a sterile site (fluid/blood/tissue) with compatible clinical features.

Of the 126 LT cases involving 115 children, 69.0% (n=87) were performed due to biliary atresia. Twenty-four IFI episodes in 20 recipients yielded a 90-day post-LT crude incidence of 19.0% and an incidence rate of 0.14 per 1000 patient-days. Invasive candidiasis predominated (95.4%) with Candida albicans (40.9%), C. parapsilosis (31.8%), and C. auris (9.1%). The most common clinical manifestations were peritonitis (54.2%) and fungemia (16.7%). Emergency LT [subdistribution hazard ratio (sHR), 3.97; 95% confidence interval (CI), 1.39-11.3; p=0.010] and reoperation or interventional procedures (sHR, 4.05; 95% CI, 1.53-10.7; p=0.005) were independently associated with IFI. One-year overall survival was significantly lower in the IFI group than in the non-IFI group (58.4% vs. 82.8%, p=0.037).

IFIs impose a burden on pediatric LT recipients in Korea and are associated with poorer survival. These data support the consideration of universal antifungal prophylaxis. However, multicenter studies are warranted to validate these findings and define the prophylaxis regimen.