TY - JOUR
T1 - Risk factors for early invasive fungal infections in paediatric liver transplant recipients
AU - Pasternak, Yehonatan
AU - Rubin, Shiri
AU - Bilavsky, Efraim
AU - Mozer-Glassberg, Yael
AU - Levy, Itzhak
AU - Nahum, Elhanan
AU - Rom, Eran
AU - Gurevich, Michael
AU - Ben-Zvi, Haim
AU - Ashkenazi-Hoffnung, Liat
N1 - Publisher Copyright:
© 2018 Blackwell Verlag GmbH
PY - 2018/9
Y1 - 2018/9
N2 - 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.
AB - 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.
KW - candida
KW - fungal infections
KW - liver
KW - paediatric
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=85051445140&partnerID=8YFLogxK
U2 - 10.1111/myc.12784
DO - 10.1111/myc.12784
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C2 - 29663565
AN - SCOPUS:85051445140
SN - 0933-7407
VL - 61
SP - 639
EP - 645
JO - Mycoses
JF - Mycoses
IS - 9
ER -