Patterns of infection after pediatric liver transplantation.

OBJECTIVE

To characterize the patterns of infection that occur after orthotopic liver transplantation in children.

DESIGN

Inception cohort, retrospective.

SETTING

Referral center for liver transplantation, university hospital.

PATIENTS

Thirty-six consecutive children who underwent orthotopic liver transplantation and who survived for at least 48 hours after transplantation.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Twenty-six (72%) of the children had at least one infection, and infection caused four deaths. More infections occurred when prophylactic antilymphocyte antibodies were given than when they were not given (2.9 vs 1.0 infections per transplant). The risk of infection was greatest during the first 2 weeks after orthotopic liver transplantation. Most infections were caused by bacteria (52 cases), followed by viruses (16 cases) and fungi (11 cases). Bacteria were the most common pathogens during all periods, except the third and fourth weeks, when viruses predominated. The most common primary sites of bacterial infection were abdomen (15 cases), bloodstream (15 cases), and surgical wound (10 cases); the most frequent isolates were aerobic gram-negative bacilli (48% of isolates) and enterococci (19%). Cytomegalovirus was the most common viral pathogen (seven cases), and Candida albicans caused all fungal infections. Fungal infections were significantly associated with systemic antibiotic therapy and abdominal complications.

CONCLUSIONS

Characteristic patterns of infection occur after pediatric orthotopic liver transplantation, and knowledge of these patterns is likely to result in improved care for transplant recipients.