Blood stream infections in children in the first year after liver transplantation at Wits Donald Gordon Medical Centre, South Africa

Abstract

Children who undergo liver transplantation and subsequently develop BSI are at risk for adverse outcomes. Research from high‐income settings contrasts the dearth of information from transplant centers in low‐ and middle‐income countries, such as South Africa. Therefore, this study from Johannesburg aimed to describe the clinical and demographic profile of children undergoing liver transplantation, and determine the incidence and pattern of BSI and associated risk factors for BSI during the first year after liver transplant. Pediatric liver transplants performed from 2005 to 2014 were reviewed. Descriptive analyses summarized donor, recipient, and post‐transplant infection characteristics. Association between BSI and sex, cause of liver failure, age, nutritional status, PELD/MELD score, graft type, biliary complications, and acute rejection was determined by Fisher's exact test; and association with length of stay by Cox proportional hazards regression analysis. Survival estimates were determined by the Kaplan‐Meier method. Sixty‐five children received one transplant and four had repeat transplants, totaling 69 procedures. Twenty‐nine BSI occurred in 19/69 (28%) procedures, mostly due to gram‐negative organisms, namely Klebsiella species. Risk for BSI was independently associated with biliary atresia (44% BSI in BA compared to 17% in non‐BA transplants; P = .014) and post‐operative biliary complications (55% BSI in transplants with biliary complications compared to 15% in those without; P = .0013). One‐year recipient and graft survival was 78% (CI 67%‐86%) and 77% (CI 65%‐85%), respectively. In Johannesburg, incident BSI, mostly from gram‐negative bacteria, were associated with biliary atresia and post‐operative biliary complications in children undergoing liver transplantation.

Healthcare disparity and its associations with cytomegalovirus disease in pediatric liver transplant recipients in South Africa

“…Tacrolimus was dosed twice a day from day 1 post‐transplantation, and titrated to maintain tacrolimus levels between 10 and 14 ng/ml for the first month, 8–10 ng/ml for the next 3 months, and 6–8 ng/ml thereafter for the first year. 17 Mycophenolate mofetil or azathioprine was added as a second agent in PLT recipients who had more than two episodes of acute cellular rejection, plasma‐rich rejection, or autoimmune hepatitis. All PLT recipients with steroid‐resistant rejection received a lymphocyte‐depleting agent such as thymoglobulin, accompanied by oral valganciclovir prophylaxis.…”

“…A dosage of 10 mg/kg of intravenous methylprednisolone was administered after reperfusion of the graft and then given at 1 mg/kg daily for the first week after transplant, weaned to 0.5 mg/kg daily for the second week and then changed to oral prednisone, weaned to 0.25 mg/kg daily thereafter and stopped at 3 months except in patients with autoimmune hepatitis who were kept on low‐dose steroids. Tacrolimus was dosed twice a day from day 1 post‐transplantation, and titrated to maintain tacrolimus levels between 10 and 14 ng/ml for the first month, 8–10 ng/ml for the next 3 months, and 6–8 ng/ml thereafter for the first year 17 . Mycophenolate mofetil or azathioprine was added as a second agent in PLT recipients who had more than two episodes of acute cellular rejection, plasma‐rich rejection, or autoimmune hepatitis.…”

Incidence, causative organisms, and risk factors of bloodstream infections in pediatric liver transplant patients: a systematic review

“…Finally, 14 full-text studies were included in this systematic review (Table 1). 5,[13][14][15][16][17][18][19][20][21][22][23][24][25] The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the study search and selection process is displayed in Fig. 1.…”

“…In this review, 13 retrospective cohort studies and one case control study were included for a total of 14 studies from France, Iran, Japan, Korea, South Africa, Thailand, Turkey, and the US. The extracted data included the BSI rates (Table 1), organisms identified (Table 2), 5,13,16,[18][19][20]22,23) prophylactic antibiotics used (Table 3), 5,13,[15][16][17]19,20,[22][23][24] and risk factors (Table 4). 13,[19][20][21]23) The patient population comprised 50.9% males (n=1,283), with a mean age of 25 months.…”

“…The extracted data included the BSI rates (Table 1), organisms identified (Table 2), 5,13,16,[18][19][20]22,23) prophylactic antibiotics used (Table 3), 5,13,[15][16][17]19,20,[22][23][24] and risk factors (Table 4). 13,[19][20][21]23) The patient population comprised 50.9% males (n=1,283), with a mean age of 25 months. A total of 4,812 LT were performed, 68% (n=1,481) of which were from living donors.…”