Epidemiology and Risk Factors for Viral Infections in Pediatric Liver Transplant Recipients and Impact on Outcome

Abstract

Infections after liver transplantation (LT) are risk factors for morbidity and mortality. Infections, especially of viral etiologies, still have an impact on the graft function and overall outcome. The aim was to review the epidemiology and risk factors of EBV, CMV and non-EBV non-CMV viral infections and their impacts on outcomes after LT. Demographic, clinical, and laboratory data were retrieved from patients’ electronic databases. Over 2 years, 96 patients were transplanted at the Pediatric Liver Centre at Kings College Hospital. The majority of the infections were of viral origin; 73 (76%) patients. The incidence of EBV viremia was 60.4%, CMV infection 35.4%, and other viruses 30%. Older donor age, auxiliary graft, and bacterial infections were risk factors for EBV infection. Younger recipient age, D+R− CMV IgG, and left lateral segment graft were risk factors for CMV infection. More than 70% of patients with non-EBV and CMV viral infections stayed positive post-LT but did not contribute to increased complications. Despite the high prevalence of viral infections, EBV, CMV, and non-EBV non-CMV viral infections were not associated with rejection, morbidity, or mortality. Although some of the risk factors for viral infections are unavoidable, identifying the characteristics and risk pattern will help improve the care for pediatric LT recipients.

A quick algorithmic review on management of viral infectious diseases in pediatric solid organ transplant recipients

“…Among this vulnerable population, delayed detection and management of viral infections can lead to significant levels of morbidity and mortality ( 8 , 9 ). The most commonly observed viral infections following solid organ transplantation include CMV, EBV, HSV, VZV, adenoviruses, BK polyomavirus, and respiratory viruses like Influenza ( 10 , 11 ).…”