Patterns of infection after pediatric liver transplantation

D. L. George, P. M. Arnow, A. Fox, J. R. Thistlethwaite, J. C. Emond, C. E. Broelsch and P. F. Whitington
Department of Medicine, University of Chicago Hospitals, IL.

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.