Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

• Published in: American journal of transplantation Vol. 8; no. 2; pp. 396 - 403
• Main Authors: Shepherd, R. W., Turmelle, Y., Nadler, M., Lowell, J. A., Narkewicz, M. R., McDiarmid, S. V., Anand, R., Song, C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2008; Blackwell
• Subjects: Adolescent; Biological and medical sciences; Cause of Death; Child; Epidemiology; Epstein-Barr virus; General aspects; Graft Rejection - epidemiology; Graft Rejection - mortality; Humans; Immunosuppressive Agents - therapeutic use; Infection; Infections - epidemiology; Infections - mortality; liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Liver Transplantation - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; pediatric; Postoperative Complications - epidemiology; Probability; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recurrence; rejection; Reoperation - mortality; Reoperation - statistics & numerical data; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Treatment Failure; Human; Graft(material); Pediatrics; risk factors; Digestive system; Liver; Homotransplantation; Epidemiology; pediatric; Infection; Rejection; Treatment; Surgery; Risk factor; Graft; Child; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2007.02068.x

Rejection and infection are important adverse events after pediatric liver transplantation, not previously subject to concurrent risk analysis. Of 2291 children (<18 years), rejection occurred at least once in 46%, serious bacterial/fungal or viral infections in 52%. Infection caused more deaths than rejection (5.5% vs. 0.6% of patients, p < 0.001). Early rejection (<6 month) did not contribute to mortality or graft failure. Recurrent/chronic rejection was a risk in graft failure, but led to retransplant in only 1.6% of first grafts. Multivariate predictors of bacterial/fungal infection included recipient age (highest in infants), race, donor organ variants, bilirubin, anhepatic time, cyclosporin (vs. tacrolimus) and era of transplant (before 2002 vs. after 2002); serious viral infection predictors included donor organ variants, rejection, Epstein‐Barr Virus (EBV) naivety and era; for rejection, predictors included age (lowest in infants), primary diagnosis, donor‐recipient blood type mismatch, the use of cyclosporin (vs. tacrolimus), no induction and era. In pediatric liver transplantation, infection risk far exceeds that of rejection, which causes limited harm to the patient or graft, particularly in infants. Aggressive infection control, attention to modifiable factors such as pretransplant nutrition and donor organ options and rigorous age‐specific review of the risk/benefit of choice and intensity of immunosuppressive regimes is warranted. In this systematic concurrent analysis of rates and risks of rejection and infection in 2291 pediatric liver transplants, infection risk far exceeded that of rejection, which caused limited harm to the patient or graft, particularly in infants.