Blood stream infections in children in the first year after liver transplantation at Wits Donald Gordon Medical Centre, South Africa.
Adolescent
Child
Child, Preschool
Developing Countries
Female
Follow-Up Studies
Humans
Incidence
Infant
Infant, Newborn
Kaplan-Meier Estimate
Liver Transplantation
Male
Postoperative Complications
/ diagnosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Sepsis
/ diagnosis
South Africa
blood stream infection
end stage liver disease
liver transplant
low and middle income country
mortality
pediatric
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
03
05
2019
revised:
10
12
2019
accepted:
03
01
2020
pubmed:
28
1
2020
medline:
9
3
2021
entrez:
28
1
2020
Statut:
ppublish
Résumé
Children who undergo liver transplantation and subsequently develop BSI are at risk for adverse outcomes. Research from high-income settings contrasts the dearth of information from transplant centers in low- and middle-income countries, such as South Africa. Therefore, this study from Johannesburg aimed to describe the clinical and demographic profile of children undergoing liver transplantation, and determine the incidence and pattern of BSI and associated risk factors for BSI during the first year after liver transplant. Pediatric liver transplants performed from 2005 to 2014 were reviewed. Descriptive analyses summarized donor, recipient, and post-transplant infection characteristics. Association between BSI and sex, cause of liver failure, age, nutritional status, PELD/MELD score, graft type, biliary complications, and acute rejection was determined by Fisher's exact test; and association with length of stay by Cox proportional hazards regression analysis. Survival estimates were determined by the Kaplan-Meier method. Sixty-five children received one transplant and four had repeat transplants, totaling 69 procedures. Twenty-nine BSI occurred in 19/69 (28%) procedures, mostly due to gram-negative organisms, namely Klebsiella species. Risk for BSI was independently associated with biliary atresia (44% BSI in BA compared to 17% in non-BA transplants; P = .014) and post-operative biliary complications (55% BSI in transplants with biliary complications compared to 15% in those without; P = .0013). One-year recipient and graft survival was 78% (CI 67%-86%) and 77% (CI 65%-85%), respectively. In Johannesburg, incident BSI, mostly from gram-negative bacteria, were associated with biliary atresia and post-operative biliary complications in children undergoing liver transplantation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13660Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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