Risk factors for early invasive fungal infections in paediatric liver transplant recipients

Yehonatan Pasternak*, Shiri Rubin, Efraim Bilavsky, Yael Mozer-Glassberg, Itzhak Levy, Elhanan Nahum, Eran Rom, Michael Gurevich, Haim Ben-Zvi, Liat Ashkenazi-Hoffnung

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Invasive fungal infections (IFIs) postliver transplantation are a frequent cause of morbidity and mortality; however, studies reporting on these infections in the paediatric population are scarce. To investigate the incidence and risk factors of IFIs in paediatric liver transplant recipients during the early posttransplantation period (≤3 months). Data were collected for all paediatric liver transplant recipients registered in a national transplantation center from 2004 to 2014. Using a stepwise logistic regression to identify independent risk factors for IFIs, a predictive model was formulated. Ten IFIs were identified in 81 liver transplant recipients (12.3%) all occurring during the first month posttransplantation. Candida species were responsible for nine cases (90%), of which four were non-albicans Candida (44%). Significant risk factors were identified; recipient of multiple blood product transfusions during transplantation, prolonged use of indwelling intravenous catheter, prolonged IV antibiotic treatment, surgical complications, pulse steroid treatment and living donor liver transplantation. The predictive model used two clinical parameters to define high-risk patients: a living donor transplantation and duration of IV antibiotic treatment (area under the ROC curve 0.918). IFIs are a significant complication occurring in the first month posttransplantation. Future studies are required to assess efficacy of targeted antifungal prophylaxis in high risk patients.

Original languageEnglish
Pages (from-to)639-645
Number of pages7
JournalMycoses
Volume61
Issue number9
DOIs
StatePublished - Sep 2018

Keywords

  • candida
  • fungal infections
  • liver
  • paediatric
  • transplantation

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