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Infectious complications in living related liver transplantation
1Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Insights
Living related liver transplantation (LRLT) in children shows low rates of cytomegalovirus (CMV) infection due to high compatibility. Bacterial and fungal infections require improved surgical techniques, while Epstein-Barr virus (EBV) remains a challenge.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Infectious Diseases
Background:
- End-stage liver disease in children necessitates liver transplantation.
- Living related liver transplantation (LRLT) offers a viable option for pediatric patients.
- Immunosuppression strategies are crucial for graft survival and managing post-transplant complications.
Purpose of the Study:
- To evaluate the outcomes of living related liver transplantation (LRLT) in pediatric patients.
- To analyze the incidence and management of infections following LRLT.
- To assess the efficacy of combined FK-506 and low-dose steroid immunosuppression.
Main Methods:
- Retrospective analysis of 50 pediatric patients undergoing LRLT over 31 months.
- Routine immunosuppression with FK-506 and low-dose steroids.
- Detailed monitoring and recording of infectious complications, including bacterial, fungal, and viral infections.
Main Results:
- Seven deaths occurred, with two attributed to infections (Candida pneumonia, EBV-associated lymphoproliferative syndrome).
- Bacterial infections (5) were linked to surgical complications; fungal infections (3) occurred in malnourished patients with biliary atresia.
- Symptomatic viral infections (14) included CMV (5), EBV (6), and others; most were minor and successfully treated, except for EBV-associated LPS.
Conclusions:
- LRLT in children demonstrates a low incidence and successful treatment of cytomegalovirus (CMV) infections, potentially due to high graft compatibility.
- Bacterial and fungal infections can be reduced through refined surgical techniques and improved preoperative management.
- Epstein-Barr virus (EBV) infection, particularly EBV-associated lymphoproliferative syndrome (LPS), remains a significant challenge in pediatric LRLT.
Abstract:
During the last 31 months, 50 children between 3 months and 15 years of age have undergone living related liver transplantation (LRLT) for end-stage liver diseases (39 biliary atresia, 2 Budd-Chiari syndrome, 2 progressive intrahepatic cholestasis, 3 liver cirrhosis, 1 Wilson disease, 1 protoporphyria, 1 tyrosinemia, and 1 fulminant hepatitis). Combined FK-506 and low-dose steroids were routinely used for immunosuppression. There were seven deaths, two of which were related to infection (Candida pneumonia and Epstein-Barr virus [EBV]-associated lymphoproliferative syndrome [LPS]). Five patients had a bacterial infection, all of which were associated with surgical complications. Three patients had Candida infection, all of which were malnourished, had biliary atresia, and had been managed with prolonged antibiotics against obstinate ascending cholangitis. There were 14 symptomatic viral infections (1 herpes simplex virus, 1 herpes zoster virus, 5 cytomegalovirus [CMV], 6 EBV, and 1 EBV-associated LPS). Three of the five CMV infections appeared in patients whose graft was ABO-incompatible, who were managed with prophylactic OKT-3. Most of the viral infections (except 1 EBV-associated LPS) were minor and were treated successfully. The low incidence and successful treatment of CMV infection are related to the high compatibility and low incidence of allograft rejection in LRLT. Bacterial and fungal infections can be decreased by greater refinement of surgical technique and more aggressive preoperative management. Treatment of EBV infection is still an unsolved problem.