Infectious complications in living related liver transplantation

• Published in: Journal of pediatric surgery Vol. 29; no. 4; pp. 514 - 517
• Main Authors: Uemoto, Shinji, Tanaka, Koichi, Fujita, Shiro, Sano, Kaoru, Shirahase, Isao, Kato, Hironori, Yamamoto, Eiji, Inomata, Yukihiro, Ozawa, Kazue
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.04.1994; Elsevier
• Subjects: Adolescent; Bacterial Infections - prevention & control; Biological and medical sciences; Candidiasis - prevention & control; Child; Child, Preschool; Female; Humans; Infant; Infection - therapy; Liver Diseases - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Postoperative Complications - prevention & control; Postoperative Complications - therapy; Premedication; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue Donors; Virus Diseases - prevention & control; living related; Liver transplantation; Human; Prognosis; Related donor; Hepatic disease; Transplantation; Homotransplantation; Incidence; Infection; Chronic; Treatment; Partial; Surgery; Digestive diseases; Complication; Hepatic lobe; Child
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/0022-3468(94)90080-9

During the last 31 months, 50 children between 3 months and 15 years of age have undergone living related liver transplantation (LRLT) for end-stage liver diseases (39 biliary atresia, 2 Budd-Chiari syndrome, 2 progressive intrahepatic cholestasis, 3 liver cirrhosis, 1 Wilson disease, 1 protoporphyria, 1 tyrosinemia, and 1 fulminant hepatitis). Combined FK-506 and low-dose steroids were routinely used for immunosuppression. There were seven deaths, two of which were related to infection ( Candida pneumonia and Epstein-Barr virus [EBV]-associated lymphoproliferative syndrome [LPS]). Five patients had a bacterial infection, all of which were associated with surgical complications. Three patients had Candida infection, all of which were malnourished, had biliary atresia, and had been managed with prolonged antibiotics against obstinate ascending cholangitis. There were 14 symptomatic viral infections (1 herpes simplex virus, 1 herpes zoster virus, 5 cytomegalovirus [CMV], 6 EBV, and 1 EBV-associated LPS). Three of the five CMV infections appeared in patients whose graft was ABO-incompatible, who were managed with prophylactic OKT-3. Most of the viral infections (except 1 EBV-associated LPS) were minor and were treated successfully. The low incidence and successful treatment of CMV infection are related to the high compatibility and low incidence of allograft rejection in LRLT. Bacterial and fungal infections can be decreased by greater refinement of surgical technique and more aggressive preoperative management. Treatment of EBV infection is still an unsolved problem.