Infectious agents and risk factors after liver transplantation in children

AİM: Retrospective assessment of post-transplant infections, mortality and associated factors in childhood liver donor recipients. MATERIALS and METHODS: The study grup included children who were followed up by the Department of Pediatric Gastroenterology and Hepatology and underwent liver transplantation between January 2011 and December 2015 at İnonu University Liver Transplantation İnstitute. Post-transplant follow-up period was divided into 3 groups (1st posttransplant month, 2-6th posttransplant months, after 6th posttransplant month). Infection rates and associated factors during these periods were statistically evaluated. RESULTS: Ninety (54.0%) of the 167 patients were boys and 77 (46.0%) were girls (p=0,314). Transplantation age range was 5-216 months. Of patients, 13.2% were under weight and 21.5% had chronic malnutrition. Child Pugh score range was 5-15, PELD/MELD score range was -9-51. Living donor liver transplantation was performed in 70.7% of cases. A mean of 2.5 years follow-up, post-transplant mortality rate was 33.5%. At least one bacterial, viral or fungal infection was detected in 67% (n=112) of the patients. The incidence of bacterial infection was 55.7% (n=93), viral infection 33.5% (n=56) and fungal infection 9% (n=15). Of viral infections, CMV was the most common. Only Candida albicans was isolated in cases of fungal infection. İn this study it was found that pre-transplant factors including ascites, disease severity, height Z score and cholestatic liver disease, post-transplantation factors including retransplantation, post-transplant CMV infection, number of relaparotomy, post-transplant service and intensive care unit stay were correlated with infection rate, bacterial, viral and fungal infections (p<0,05). CONCLUSİON: Bacteria were the most common cause of post-transplant infections. Because the risk is higher in children who had ascites, severe liver failure, chronic malnutrition and who had relaparotomy and longer hospitalization after transplantation, there is a need for studies on the effectiveness of different prophylaxis strategies in these children. Key words: Liver transplantation, pediatric, infection