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

BACKGROUND: Survival 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. METHODS: We performed a retrospective analysis of 189 children who received LT between 2000 and 2015 at a sing...

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Autores principales: Kim, Jae Choon, Lee, Joon Kee, Yang, Song I, Park, Sun Hyoung, Yoon, Ki Wook, Lee, Hyunju, Yi, Nam Joon, Suh, Kyung Suk, Choi, Eun Hwa, Lee, Hoan Jong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630766/
http://dx.doi.org/10.1093/ofid/ofx163.1887
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author Kim, Jae Choon
Lee, Joon Kee
Yang, Song I
Park, Sun Hyoung
Yoon, Ki Wook
Lee, Hyunju
Yi, Nam Joon
Suh, Kyung Suk
Choi, Eun Hwa
Lee, Hoan Jong
author_facet Kim, Jae Choon
Lee, Joon Kee
Yang, Song I
Park, Sun Hyoung
Yoon, Ki Wook
Lee, Hyunju
Yi, Nam Joon
Suh, Kyung Suk
Choi, Eun Hwa
Lee, Hoan Jong
author_sort Kim, Jae Choon
collection PubMed
description BACKGROUND: Survival 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. METHODS: We 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 complications RESULTS: A 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). CONCLUSION: Prophylactic 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.
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spelling pubmed-56307662017-11-07 Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years Kim, Jae Choon Lee, Joon Kee Yang, Song I Park, Sun Hyoung Yoon, Ki Wook Lee, Hyunju Yi, Nam Joon Suh, Kyung Suk Choi, Eun Hwa Lee, Hoan Jong Open Forum Infect Dis Abstracts BACKGROUND: Survival 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. METHODS: We 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 complications RESULTS: A 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). CONCLUSION: Prophylactic 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. Oxford University Press 2017-10-04 /pmc/articles/PMC5630766/ http://dx.doi.org/10.1093/ofid/ofx163.1887 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Kim, Jae Choon
Lee, Joon Kee
Yang, Song I
Park, Sun Hyoung
Yoon, Ki Wook
Lee, Hyunju
Yi, Nam Joon
Suh, Kyung Suk
Choi, Eun Hwa
Lee, Hoan Jong
Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years
title Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years
title_full Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years
title_fullStr Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years
title_full_unstemmed Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years
title_short Incidence and Risk Factors for Infections After Liver Transplant in Children: Single-Center Experience for 15 Years
title_sort incidence and risk factors for infections after liver transplant in children: single-center experience for 15 years
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630766/
http://dx.doi.org/10.1093/ofid/ofx163.1887
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