Objective: To investigate the incidence and predictors of invasive fungal infections in pediatric liver transplant recipients in the early post-transplantation period.
Background: Invasive fungal infections post-liver transplantation are an important cause of morbidity and mortality; however data in the pediatric population are scarce. Knowledge accrued regarding epidemiology and risk factors can contribute toward devising rational antifungal prophylactic and treatment strategies.
Methods: The electronic medical records of all pediatric patients, who underwent liver transplantation at Schneider Medical Center between January 2004 and December 2014, were analyzed. Data included patient demographics, clinical and laboratory parameters, microbiological studies and outcome. Patients diagnosed with invasive fungal infection were compared to their counterparts.
Results: Nine invasive fungal infections cases were identified amongst 81 liver transplant recipients (11.1%), with the majority occurring in the first month after transplantation. Candida species were responsible for 8 cases (89%), in which candidemia was diagnosed in 3 cases, urinary tract infection in 2 cases and abdominal abscess in 2 cases. One case of invasive mucormycosis was diagnosed. Significant risk factors for invasive fungal infection were a living donor (78% vs. 26%, p<0.01), recipient of multiple blood products transfusions during transplantation (12 vs. 7.6, p<0.01), prolonged hospitalization period (82.6 vs. 41.4 days, p=0.02) and pediatric intensive care unit hospitalization period (40.5 vs. 14.6 days, p<0.01), prolonged use of indwelling intravenous catheter (18.1 vs. 10.3 days, p<0.01), prolonged intravenous antibiotic treatment (61.5 vs. 15.5 days p<0.01), and pulse steroid treatment. There were no cases of fungal-infection-related mortality.
Conclusion: Invasive fungal infections are a significant early infectious complication among children post liver transplantation Antifungal prophylaxis should be considered in high-risk patients in the early post transplantation period. Future prospective studies are needed to evaluate the efficacy of a targeted anti-fungal prophylaxis approach.
