Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years

Abstract

BackgroundSurvival after liver transplantation (LT) has improved over the years, but infection is still a major complication and its incidence is higher than other organ transplantations.MethodsWe performed a retrospective analysis of 189 children who received LT between 2000 and 2015 at a single center. Data on incidence, type, and etiology of infections were collected. Risk factors were analyzed through comparison of demographic and clinical variables between patients with and without infectious complicationsResultsA total of 194 infections developed in 114 (60%) patients during the 15 year period (1.03 events per person-year). The most common pathogens were bacteria (n = 132, 68.0%), followed by virus (n = 59, 30.4%) and fungus (n = 3, 1.5%). Among bacterial pathogens, Staphylococcus aureus (15.2%), Enterococcus species (15.2%), and Klebsiella species (13.6%) were most common. Among the viruses, cytomegalovirus (44.0%) and Epstein–Barr virus (32.2%) were most common. Overall, half of the infections occurred within the first month and 87.1% within 6 months after LT. Bacterial infections occurred most frequently within the first month (n = 84, 63.6%), whereas viral infections occurred between one and six months after LT (n = 38, 64.4%). Regarding the organ infected, bloodstream was most common (n = 39, 20.1%), followed by lung (n = 30, 15.4%), peritoneum (n = 28, 14.4%), and urinary tract (n = 25, 12.9%). The overall mortality was 9.0% (n = 17), in which 47.1% (n = 8) of them were attributed to infection; septicemia (n = 4), pneumonia (n = 2), peritonitis (n = 1), and post-transplant lymphoproliferative disorder (n = 1). In multivariate analysis, age at LT <1 year (P = 0.028), cadaveric donor (P = 0.044), pediatric end-stage liver (PELD) score >14 (P = 0.023), operation time >7 hours (P = 0.002), and need of biliary or vascular intervention (P = 0.001) increased the possibility of bacterial infection. However, only long anhepatic time (>60 minutes) was associated with viral infection (P = 0.047).ConclusionProphylactic measures and monitoring for infectious complications are crucial within the first month for bacterial infection and within six months for viral infection after LT, especially in patients with risk factors.Disclosures All authors: No reported disclosures.