Early infections after living donor liver transplantation in Egyptian children [single center experience]

ABSTRACT

Liver transplantation [LT] has become an established therapeutic option for a large variety of fulminant and chronic liver diseases. Postoperative infections are the major cause of morbidity and the leading cause of mortality. The aim of this work was to investigate the incidence, types and possible predisposing factors for infection after living donor liver transplantation [LDLT] in children occurring early in the post operative period. We enrolled 22 children [10 boys [45.5%] and 12 girls[54.5%]] who underwent LDLT from 2003 to 2010 at National Liver Institute, Menofiya University, Egypt, the mean age +/- SD was 5.59 +/- 4.45 years [range, 7 months to 17yr] . We retrospectively investigated the proven episodes of bacterial, viral, and fungal infections. There were 62 infections episodes in 18 [81.2%] of 22 patients [2.8 infections/patient], two or more infections occurred in 14 out of 22 transplanted children [63.6%], bacterial infections accounted for 41 episodes of infection [66.1%], Viral infections accounted for 10 episodes of infection [16.1%] while fungal infections accounted for 11 episodes of infection [17.8%].The most common sites of bacterial infection were chest [24.4%], bile ducts [cholangitis] [17.1%] the blood stream [bacteremia] [12.2%] ,and abdomen either peritonitis or intra abdominal abscess [9.8%]. Most of the bacterial infections were polymicrobial mainly with gram negative bacilli occurred within the first month after LDLT. The most common causes of viral infection were cytomegalovirus in 4 patients, Epstein-Barr virus in 2 patients, Herpes Simplex virus types I and II presented in 4 patients. The mortality rate due to infection was 18.2% mainly caused by bacterial infection. This study found that infection is one of the important causes of morbidity and mortality after LDLT, so careful monitoring and management of infections is crucial for improving the outcome of LDLT in children