Impact of Hepatoblastoma on Infectious Complications Following Pediatric Liver Transplantation.

IF 1.2 4区 医学 Q3 PEDIATRICS
Ashton D Hall, Hope A Hendricks, Katherine A Bowers, James I Geller, Alexander J Bondoc, Greg M Tiao, Amy E Taylor, William R Otto, Grant C Paulsen, Lara A Danziger-Isakov
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引用次数: 0

Abstract

Background: Liver transplantation is the standard therapy for end-stage liver disease in pediatric patients with biliary atresia (BA), congenital and metabolic conditions, and for an unresectable malignant tumor like hepatoblastoma (HB). BA is the leading indication for pediatric liver transplantation, while HB is the most common childhood liver cancer. Despite improved outcomes through advanced surgical techniques and novel immunosuppression, pediatric liver transplantation (pLT) is complicated by post-transplant infections.

Methods: A retrospective review was performed of pLT recipients at Cincinnati Children's Hospital Medical Center (CCHMC) and stratified patients by underlying disease to assess impact on post-transplant infectious events.

Results: BA patients were youngest at pLT (12.5 months; p < 0.001) compared to other disease cohorts (HB 30.8, other 43.7). All HB patients received organs from deceased donors. In the year following pLT, 93% of the patients experienced at least one infectious event (IE). HB patients had the highest mean number of IE across disease groups (5.5 IE/patient vs. BA 4.5, other 4.0; p = 0.055), with significantly more patients with fever and neutropenia (p < 0.001) and EBV infections (p = 0.012). HB patients were more likely to develop IE earlier after pLT than non-HB groups (p = 0.013), especially Clostridioides difficile (p < 0.01) and fever and neutropenia (p < 0.01). Despite having variable IE experiences, 1-and-5-year survival across disease groups were similar.

Conclusions: IE were frequently observed in HB patients after pLT, possibly related to pre-and-postoperative chemotherapy and associated neutropenia. Underlying disease may help inform targeted infection-related patient management following pLT.

肝母细胞瘤对小儿肝移植术后感染并发症的影响。
背景:肝移植是患有胆道闭锁(BA)、先天性和代谢性疾病以及肝母细胞瘤(HB)等不可切除的恶性肿瘤的儿科终末期肝病患者的标准治疗方法。BA是儿童肝移植的主要适应症,而HB是最常见的儿童肝癌。尽管通过先进的手术技术和新型免疫抑制改善了预后,但儿童肝移植(pLT)仍存在移植后感染的并发症。方法:对辛辛那提儿童医院医学中心(CCHMC)的pLT受者进行回顾性研究,并根据基础疾病对患者进行分层,以评估移植后感染事件的影响。结果:BA患者在pLT时年龄最小(12.5个月;p结论:HB患者在pLT后经常观察到IE,可能与术前和术后化疗及相关的中性粒细胞减少有关。基础疾病可能有助于告知pLT后的针对性感染相关患者管理。
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来源期刊
Pediatric Transplantation
Pediatric Transplantation 医学-小儿科
CiteScore
2.90
自引率
15.40%
发文量
216
审稿时长
3-8 weeks
期刊介绍: The aim of Pediatric Transplantation is to publish original articles of the highest quality on clinical experience and basic research in transplantation of tissues and solid organs in infants, children and adolescents. The journal seeks to disseminate the latest information widely to all individuals involved in kidney, liver, heart, lung, intestine and stem cell (bone-marrow) transplantation. In addition, the journal publishes focused reviews on topics relevant to pediatric transplantation as well as timely editorial comment on controversial issues.
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