Pediatric Transplantation最新文献

{"title":"SARS-CoV-2-Specific Antibodies in Pediatric Solid Organ Transplant Recipients: Benefits of Additional Vaccine Doses.","authors":"Amanda L Adler, Alpana Waghmare, Jodi Smith, Megan Kelton, Jane A Dickerson, Jonathan C Reed, Alexander L Greninger, Leanne Kehoe, Tarayn Fairlie, Melissa Briggs Hagen, Claire M Midgley, Kirsten Lacombe, Janet A Englund","doi":"10.1111/petr.70050","DOIUrl":"10.1111/petr.70050","url":null,"abstract":"<p><strong>Background: </strong>Limited data are available regarding the development and durability of immune responses following COVID-19 infection or vaccination in pediatric solid-organ transplant (SOT) recipients.</p><p><strong>Methods: </strong>Renal, liver, or intestinal transplant recipients < 21 years of age followed at Seattle Children's Hospital were enrolled from August 2020 to May 2021. Blood samples were collected at ~6-month intervals for up to 3 years and tested for antinucleocapsid (N) antibodies. COVID-19 vaccination data were collected from the Washington State Immunization Information System and/or the medical record. Semi-quantitative anti-S IgG testing was performed on all postvaccine samples using the Abbott Architect platform. We further evaluated a subset of postvaccine samples using variant-specific quantitative binding (Meso Scale Discovery, MSD) immunoassays and pseudovirus-neutralization assays. Antibody levels were compared over time and by vaccine category.</p><p><strong>Results: </strong>We followed 83 SOT recipients for a median of 12.5 months (IQR 7.0, 28.3). Overall, 16 (19.3%) participants had evidence of SARS-CoV-2 infection based on anti-N antibody detection. Forty-six (55%) participants had a blood sample collected > 14 days after receipt of a vaccination. Serum IgG to spike antigens (anti-S antibody) increased following vaccination and increased with the number of vaccine doses received as assessed by both the Abbott and MSD assays. Neutralizing activity was significantly lower against the Omicron subvariants compared to the ancestral strain.</p><p><strong>Conclusion: </strong>Pediatric SOT recipients demonstrated strong antibody responses following SARS-CoV-2 vaccination, with higher anti-S antibody responses following > 2 doses of vaccine. Our study offers unique longitudinal immune response data in this vulnerable patient population.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70050"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Transplant Surgeons' Perspectives on Palliative Care for Children With Chronic Kidney Disease: A National Cross-Sectional Survey.","authors":"Taylor R House, Aaron Wightman, Jodi Smith, Andre Dick, Miranda C Bradford, Abby R Rosenberg","doi":"10.1111/petr.70037","DOIUrl":"10.1111/petr.70037","url":null,"abstract":"<p><strong>Background: </strong>Some adult transplant surgeons consider transplant to be contraindicated in patients receiving palliative care (PC). Little is known about pediatric transplant surgeons' attitudes toward PC. We sought to ascertain pediatric kidney transplant surgeons' perspectives regarding the routine integration of PC for children with chronic kidney disease.</p><p><strong>Method: </strong>We administered a cross-sectional web-based survey to members of the American Society of Transplant Surgeons listserv in summer 2021. We adapted the survey from the previously validated Provider Survey about Palliative Care for Children with Heart Disease and pretested it with representative kidney transplant surgeons, nephrologists, and PC physicians; queries related to PC included institutional and personal experience, knowledge, and education. Data were summarized descriptively.</p><p><strong>Results: </strong>There were 21 participants. Over half of the respondents were white (57%) males (62%), practicing in urban, academic centers (94%). Although 67% of the participants practiced in an institution with a subspecialty PC team, 24% were unsure if such a team existed in their institution. A minority (19%) perceived PC consultation and kidney transplant to be mutually exclusive. Most surgeons (86%) believed that PC should not be restricted to when a child is dying, and 59% reported that PC consultation should happen at diagnosis for life-threatening conditions. However, surgeons indicated that PC consultation is rarely utilized for pediatric kidney transplant recipients. Transplant surgeons expressed a desire for additional PC-focused training and willingness to engage in additional education.</p><p><strong>Conclusions: </strong>Although a minority of pediatric transplant surgeons perceived PC to be contraindicated for kidney transplant, most indicated openness to PC engagement for their patients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70037"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Risk Factors for Graft Failure due to Chronic Rejection < 15 Years Post-Transplant in Pediatric Kidney Transplants Using Random Forest Machine-Learning Techniques.","authors":"Hyewon Suh","doi":"10.1111/petr.70043","DOIUrl":"10.1111/petr.70043","url":null,"abstract":"<p><strong>Background: </strong>Chronic rejection forms the leading cause of late graft loss in pediatric kidney transplant recipients. Despite improvement in short-term graft outcomes, chronic rejection impedes comparable progress in long-term graft outcomes.</p><p><strong>Methods: </strong>Data from the national Standard Transplant Analysis and Research (STAR) quarterly file from 1987 to 2023, provided by the Organ Procurement and Transplantation Network (OPTN), and machine-learning techniques were leveraged to determine novel risk factors for graft failure due to chronic rejection in pediatric kidney transplants. A predictive model was developed in conjunction, based on the performances of six classification models, including logistic regression, k-Nearest Neighbors, Support Vector Machine, Decision Tree, Artificial Neural Network, and Random Forest.</p><p><strong>Results: </strong>The 19 pre-transplant and at-transplant factors identified include those substantiated in literature, such as living donor type, cold ischemic time, human leukocyte antigen (HLA) matching, recipient age, and recipient race. Other factors include one-haplotype matched transplants, recipient age being < 5 years, and the proximities of the most and least recent serum crossmatch tests to transplantation. The latter may correlate with recipient sensitization and socioeconomic disparities, but further research must be done to validate this hypothesis. The Random Forest model was selected based on its performance metrics (AUC 0.81).</p><p><strong>Conclusions: </strong>This case-control study identifies key factors for chronic rejection-caused graft failure 15 years post-transplant in pediatric kidney transplants and develops a Random Forest predictive model based on these factors. Continued investigation is needed to better understand the variables contributing to pediatric chronic kidney rejection.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70043"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Liver Transplantation in a Pediatric Patient With Transaldolase Deficiency.","authors":"Ahmet Atasever, Sinan Efe Yazici, Ebru Turan, Dilek Guller, Yildiray Yuzer","doi":"10.1111/petr.70049","DOIUrl":"10.1111/petr.70049","url":null,"abstract":"<p><strong>Background: </strong>Transaldolase deficiency (TALDO) is a rare autosomal recessive disorder of the pentose phosphate pathway, presenting with end-stage liver disease, renal tubular dysfunction, and coagulopathies. Liver transplantation has emerged as a potential treatment for end-stage liver disease in TALDO patients, though clinical evidence is limited to seven reported cases.</p><p><strong>Methods: </strong>We describe the case of a pediatric patient with TALDO who successfully underwent living donor liver transplantation. Clinical, preoperative, surgical, and postoperative data were reviewed and compared with previously reported cases.</p><p><strong>Results: </strong>A 3-year 4-month-old girl with TALDO presented with end-stage liver disease, recurrent bleeding, and suspected hepatocellular carcinoma (HCC). She received a left lateral segment graft from her father. Postoperatively, coagulopathy and bleeding episodes resolved, with stable liver function at 1 year. Histopathology revealed cirrhosis without HCC. Complications included bile duct stenosis, successfully managed.</p><p><strong>Conclusions: </strong>This case emphasizes liver transplantation as a lifesaving option for TALDO patients with end-stage liver disease. While short-term outcomes are promising, further studies are needed to evaluate long-term prognosis and growth outcomes. Reporting additional cases is vital to refine management strategies.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70049"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Pharmacogenomic Testing in Pediatric Heart and Kidney Transplant.","authors":"Rachel L Jackson, Caroline Heyrend, Bridget Bucher, Ashlie Brewer, Caitlin Peterson, Lindsay J May, Joshua L Bonkowsky","doi":"10.1111/petr.70044","DOIUrl":"10.1111/petr.70044","url":null,"abstract":"<p><strong>Background: </strong>Pediatric solid organ transplantation is a complex process including a tightly orchestrated medication regimen, essential for prevention of infection, rejection, graft failure, and mortality. Pharmacogenomic (PGx) testing tailors medication therapy to the individual patient, focusing on safety, efficacy, and avoidance of adverse effects. Implementation of PGx panel results into clinical practice for pediatric transplant patients has not been evaluated.</p><p><strong>Methods: </strong>Pediatric patients evaluated for heart, kidney, or combined heart-kidney transplant at a tertiary children's hospital from October 2021 to October 2023 received PGx panel testing.</p><p><strong>Primary outcome measure: </strong>Report the prevalence of actionable PGx variants for key genes impacting pharmacotherapy in pre- and post-heart and kidney transplant populations.</p><p><strong>Results: </strong>A total of 73 patients were included, predominately white (84.9%) and male (64.4%), with a mean age of 8.8 ± 6.4 years. Indications for PGx testing included evaluation for heart transplant (38.4%), kidney transplant (38.4%), combined heart-kidney transplant (4.1%), or to inform posttransplant care (19.2%). All patients had at least one actionable phenotype identified. 37 of 73 patients (50.7%) had at least one actionable phenotype for the transplant-specific genes captured including CYP3A5, SLCO1B1, G6PD, TPMT, prothrombin (Factor 2), and Factor V Leiden. 16 of 73 patients (21.9%) had actionable CYP3A5 phenotypes. 15 of 73 (20.5%) had actionable SLCO1B1 phenotypes. 9 of 73 patients (12.3%) had actionable TPMT phenotypes. 5 of 73 (6.8%) had Prothrombin or Factor V Leiden variants.</p><p><strong>Conclusions: </strong>Routine pretransplant PGx testing provided information that was actionable and could be utilized to optimize posttransplant medications for all patients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70044"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Transplantation in Children and Adolescents With C3 Glomerulopathy or Immune Complex Membranoproliferative Glomerulonephritis: An International Survey of Current Practice.","authors":"Christian Patry, Nicholas J A Webb, Matthias Meier, Lars Pape, Alexander Fichtner, Britta Höcker, Burkhard Tönshoff","doi":"10.1111/petr.70048","DOIUrl":"10.1111/petr.70048","url":null,"abstract":"<p><strong>Background: </strong>Approximately 50% of patients with chronic kidney disease due to C3 glomerulopathy (C3G) or primary immune-complex membranoproliferative glomerulonephritis (IC-MPGN) will require dialysis and/or kidney transplantation (KTx) within the first 10 years of disease onset. Currently, there are no guidelines regarding the indications for KTx or post-transplant management.</p><p><strong>Methods: </strong>We therefore initiated an international online survey via Survey Monkey on C3G and IC-MPGN in children with CKD stage 5. All KTx centers of the European Society for Paediatric Nephrology (ESPN) were invited to participate in the survey, which was conducted from August 23 to November 25, 2023.</p><p><strong>Results: </strong>Sixty-five (63%) of the centers (n = 103) participated. Twenty-six percent had made at least one decision against living donation for a child with C3G or IC-MPGN. The main reason for 88.2% of these decisions was concern about the recurrence of the underlying disease in any potential transplant. Eighty-eight percent indicated deceased donation as an option; 12% decided not to proceed with transplantation at all. Regarding KTx decision-making or management, none of them referred to an existing recommendation by any national or regional guideline. For the recurrence of C3G or IC-MPGN post-transplant, eculizumab treatment was suggested by 60% of respondents.</p><p><strong>Conclusion: </strong>This survey shows a considerable reluctance of pediatric nephrologists to list patients with CKD stage 5 due to C3G or IC-MPGN for living donor kidney transplantation. This decision is mainly based on the fear of recurrence of the underlying disease combined with the lack of reliable treatment options. This limited access of affected patients to the best treatment option for kidney failure requires further action.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70048"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Early Immunosuppression Center Variability and One-Year Outcomes After Pediatric Liver Transplant.","authors":"Vikram K Raghu, Scott D Rothenberger, James E Squires, Elizabeth Eisenberg, Anna L Peters, Jennifer Halma, Swati Antala, Irini D Batsis, Ke-You Zhang, Amy G Feldman, Daniel H Leung, Steven J Lobritto, John Bucuvalas, Simon P Horslen, George V Mazariegos, Emily R Perito","doi":"10.1111/petr.70018","DOIUrl":"10.1111/petr.70018","url":null,"abstract":"<p><strong>Background: </strong>Despite the existence of institutional protocols, liver transplant centers often have variability in early immunosuppression practices. We aimed to measure within-center variability in early immunosuppression after pediatric liver transplant (LT) and examine its association with one-year outcomes.</p><p><strong>Methods: </strong>We analyzed pediatric LTs from 2013 to 2018 in the United Network for Organ Sharing registry, with data aggregated by center. We categorized induction regimen as corticosteroids only vs. T-cell depleting antibody vs. non-T-cell depleting antibody. Primary exposures were coefficient of immunosuppression variability (CIV) in (1) induction and (2) mycophenolate mofetil (MMF) use. Primary outcomes were one-year graft survival, patient survival, and acute rejection rate within the first year after transplant.</p><p><strong>Results: </strong>The study cohort included 2542 LT recipients from 67 LT centers. Sixteen centers (24%) had no MMF variability; twenty-five centers (37%) had no induction variability. In multivariable analysis, induction CIV was associated with 2.72 times greater odds of acute rejection in the first year (OR 2.72; 95% CI 1.66-4.45; p < 0.001). MMF CIV was not associated with rejection (OR 1.22, 95% CI 0.66-2.25, p = 0.527). Neither one-year graft nor patient survival were associated with induction or MMF CIV.</p><p><strong>Conclusions: </strong>Induction CIV is associated with higher one-year acute rejection odds and did not impact short-term graft or patient survival. Improved understanding of the reasons for high CIV will inform future work aiming to determine whether reducing variability may improve outcomes.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70018"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living Donor Liver Transplantation for Young Biliary Atresia Recipients Is Associated With Improved Outcomes in the Modern Era.","authors":"Ioannis A Ziogas, Dor Yoeli, Megan A Adams, Michael E Wachs, Amy G Feldman, Sarah A Taylor","doi":"10.1111/petr.70031","DOIUrl":"10.1111/petr.70031","url":null,"abstract":"<p><strong>Introduction: </strong>Biliary atresia (BA) is the most common indication for liver transplantation (LT) in children. We aimed to identify risk factors associated with survival in young patients with BA in the modern era.</p><p><strong>Methods: </strong>We performed a retrospective analysis of BA patients aged < 2 years who received their first isolated LT with available data from the United Network for Organ Sharing database (01/2013-12/2022). Factors included in the multivariable Cox regression were graft type, race/ethnicity, insurance status, laboratory pediatric end-stage liver disease (PELD) score, history of portal vein thrombosis, and intensive care unit (ICU) status.</p><p><strong>Results: </strong>1226 BA LT recipients aged < 2 years were included, of whom 501 (40.9%) received deceased donor whole grafts (DDWG), 425 (34.7%) received deceased donor technical variants (DDTV), and 300 (24.5%) received living donor LT (LDLT). LDLT recipients were more likely to be white (p = 0.008) and have private insurance (p < 0.001). Multivariable analysis demonstrated that ICU status (hazard ratio [HR] = 3.23, 95% confidence interval [95% CI]: 1.72-6.08, p < 0.001) and DDTV graft vs. LDLT (HR = 3.03, 95% CI: 1.14-8.04, p = 0.03) were associated with an increased risk of patient mortality. Factors associated with an increased risk of graft loss included ICU status (HR = 1.89, 95% CI: 1.19-3.00, p = 0.007) and both DDWG (HR = 3.37, 95% CI: 1.65-6.87, p = 0.001) and DDTV (HR = 3.47, 95% CI: 1.69-7.14, p = 0.001) grafts vs. LDLT.</p><p><strong>Conclusion: </strong>LDLT is associated with improved survival in patients with BA aged < 2 years; however, socioeconomic differences exist between LDLT and non-LDLT recipients. Efforts to promote early equitable referral to centers offering LDLT are essential for improving outcomes in young children with BA.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70031"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Living Donor Liver Transplantation as a Solution in Medical Treatment-Resistant Cystathionine-β-Synthase Deficiency: A Single-Center Case Series.","authors":"Yong-Fa Huang, Lin Wei, Wei Qu, Zhi-Gui Zeng, Li-Ying Sun, Zhi-Jun Zhu","doi":"10.1111/petr.70011","DOIUrl":"10.1111/petr.70011","url":null,"abstract":"<p><strong>Introduction: </strong>Cystathionine-β-synthase deficiency (CBSd) is an inherited metabolic liver disease causing morbidities in eyes, skeleton, brain, and vasculature. Despite its potential lethality due to thromboembolism and liver failure, sole diagnosis of CBSd seemed not to fulfill the enlistment criteria for deceased donor liver transplantation in previous reports.</p><p><strong>Methods: </strong>We retrospectively reviewed three cases of living donor liver transplantation (LDLT) for pediatric CBSd patients responding poorly to conservative treatment in Beijing Friendship Hospital, and a literature review was performed.</p><p><strong>Results: </strong>Patients 1 and 3 received donated partial liver from heterozygous carrier parents, and Patient 2 received donated partial liver from a CBS-competent parent. Patient 2 developed portal thrombus 1 day after LDLT, which was resolved with surgical thrombectomy and reconstruction. Patients 1 and 3 had their resected liver donated to other patients with advanced liver cancer, and the domino grafts functioned well until the death due to tumor recurrence.</p><p><strong>Conclusion: </strong>Parental LDLT, whether from carriers or not, is an appropriate alternative for CBSd patients resistant to medical treatment. Risk of peri-operative thromboembolism might be higher in CBSd than in other LDLT cases, and explanted livers with CBSd could serve as domino grafts.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70011"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of Infection After Pediatric Liver Transplant and Its Associated Risk Factors.","authors":"Soichiro Tanimura, Soo Lin Chuah, Seiichi Shimizu, Seisuke Sakamoto, Mureo Kasahara, Satoshi Nakagawa","doi":"10.1111/petr.70032","DOIUrl":"10.1111/petr.70032","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation has improved survival rates in pediatric patients with end-stage liver failure. However, post-liver transplant infection remains a threat to patient recovery. This study reported the frequency and patterns of infections after liver transplantation and identified factors related to the accuracy of fever source investigation.</p><p><strong>Method: </strong>This is a single-center descriptive and retrospective study in the quaternary Pediatric Intensive Care Unit (PICU) in Japan. All pediatric patients who underwent liver transplantation from 2019 to 2021 were eligible. The patients were divided into two groups based on culture positivity: the positive culture group and the negative culture group.</p><p><strong>Results: </strong>A total of 152 pediatric patients were included in the study. The median age was 11 months, and 86% of cases underwent living donor liver transplantation. Among the 152 cases, 18% showed positive bacterial culture results. The timing of positive culture varied bimodally, with 34% occurring after postoperative day 15. Among the positive cultures, 84% were bacterial, and 20% were fungal. Factors associated with positive culture were analyzed, and as a result, re-laparotomy and a higher graft recipient weight ratio (GRWR) were identified as factors associated with infection.</p><p><strong>Conclusions: </strong>We reported the frequency and patterns of infections in pediatric patients undergoing living donor liver transplantation and demonstrated that factors associated with positive culture were re-laparotomy and GRWR. This study provides important clinical data for infection management after liver transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70032"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}