Assessment of pathogens and risk factors associated with bloodstream infection in the year after pediatric liver transplantation

Table 1 Demographics and details of pediatric liver transplantation

Characteristics	Total n = 378, n (%) or median (IQR)
Primary LDLT: DDLT	287 (76): 91 (24)
Age, year	1.58 (0.83-5.42)
Male: Female	176 (47): 202 (53)
Height, z-score	-0.79 (-1.81-0.27)
Weight, z-score	-0.23 (-1.13-0.62)
Growth failure	94 (25)
Indications
Biliary atresia	200 (53)
Acute liver failure	88 (23)
Metabolic liver	45 (12)
Malignancy	25 (6.6)
Other liver disease	20 (5.3)
Urgency of LT
PELD	15.4 (10.6-23.2)
MELD	27.4 (23-29)
Ventilator	25 (6.6)
Renal replacement	19 (5)
Liver support system	20 (5.3)
Graft type
LDLT, including dual LT	287 (76)
DDLT split	54 (14)
DDLT whole liver	37 (10)
ABO incompatible	11 (3)
Graft-recipient weight ratio, %	2.5 (1.69-3.22)
Total operation time, hours	6.9 (5.9-8.8)
Volume of RBC transfusion, cc/kg	19.2 (7.7-33.3)
Post-LT hospital stay, days	36 (26-51)
Surgical complication
Hepatic artery	4 (1.1)
Portal vein	51 (13)
Hepatic vein	39 (10)
Bile duct	21 (5.6)
Re-operation	50 (13)
Cytomegalovirus infection	222 (59)
Epstein–Barr virus infection	259 (69)
Post-transplant lymphoproliferative disorder	14 (3.7)
Acute cellular rejection	186 (49)
Chronic rejection	19 (5)
Patients with ≥ 1 BSI episode	106 (28)
Total BSI cases	162 (1.5 times per patient)
Graft loss	58 (15)
Patient loss	34 (9)

BSI: Blood stream infection; DDLT: Deceased donor liver transplantation; IQR: Interquartile range; LDLT: Living donor liver transplantation; MELD: Model for End-Stage Liver Disease; PELD: Pediatric End-Stage Liver Disease.

Table 2 Characteristics of blood stream infection in the first year after liver transplantation

Characteristics	n (%)
Number of patients complicated by BSI	106/378 (28)
Number of BSI episodes	162
Number of BSI episodes per patient
0	272 (72)
1	71 (19)
2	24 (6)
3	4 (1.1)
≥ 4	7 (1.9)
Organisms (% of all organisms)	176 (100)
Gram-positive bacteria	133 (76)
Coagulase-negative staphylococci	67 (38)
Enterococcus spp.	21 (12)
Streptococci	17 (10)
Staphylococcus aureus	5 (2.8)
Other gram-positive pathogens	23 (13)
Gram-negative bacteria	41 (23)
Klebsiella spp.	11 (6.3)
Enterobacter spp.	9 (5.1)
Escherichia coli	6 (3.4)
Pseudomonas aeruginosa	3 (1.7)
Other gram-negative pathogens	12 (6.8)
Fungus	2 (1.1)
Candida albicans	2 (1.1)
Time of onset after LT (% of all BSI)
0-30 d	98 (60)
31 d-6 mo	48 (30)
6 mo-1 yr	16 (10)
Origin (focus) of BSI (% of all organisms)
Unknown	94 (53)
Catheter-related infection	65 (37)
Intraabdominal infection	11 (6.2)
Urinary tract infection	3 (1.7)
Respiratory infection	3 (1.7)

BSI: Blood stream infection; LT: Liver transplantation.

Table 3 Multivariate analyses of risk factors for blood stream infection after liver transplantation

Variables	Non-BSI, n = 272		BSI, n = 106			Multivariate analysis
	Median or n	(IQR) or (%)	Median or n	(IQR) or (%)	P value1	ORs	95%CI	P value
Age	1.83	(0.86-6.0)	1.17	(0.75-3.08)	0.005	2.1	(1.18-3.77)	0.011
Sex, male	124	(45.6)	52	(49)	0.544
Height, z-score	-0.66	(-1.60-0.34)	-1.23	(-2.17-0.0)	0.005	1.1	(0.54-2.37)	0.722
Weight, z-score	-0.07	(-1.04-0.71)	-0.53	(-1.7-0.4)	0.002	1.2	(0.70-2.25)	0.438
Growth failure	52	(19)	42	(40)	< 0.001	2.1	(1.01-4.47)	0.045
Diagnosis: Biliary atresia	134	(49)	66	(62)	0.023	1.2	(0.66-2.15)	0.546
Ventilator	14	(5.1)	11	(10)	0.066
Renal replacement	11	(4.0)	8	(7.5)	0.161
Liver support system	10	(3.7)	10	(9.4)	0.025	4.2	(1.45-12.09)	0.008
PELD	16.2	(6.40-23.7)	15.5	(10.6-24.3)	0.209
MELD	27.1	(11.3-32.3)	29	(27.8-29.7)	0.746
LT, DDLT	71	(26)	20	(19)	0.139
ABO mismatch	8	(2.9)	3	(2.8)	0.954
Operation time, min	417	(357-536)	411	(350-507)	0.408
RBC transfusion, cc/kg	17.4	(7.6-29.5)	25.7	(9.8-42.1)	0.003	1.5	(0.87-2.50)	0.146
Post-LT hospital stay	36	(26-50)	41	(28-67)	0.002	2.3	(1.35-3.91)	0.002
Donor, male	128	(47)	44	(42)	0.33
Donor, body mass index	22.3	(20.3-24.4)	22.7	(21.1-24.5)	0.267
Reoperation	29	(11)	21	(20)	0.018	1.30	(0.64-2.61)	0.470
Hepatic artery complication	2	(0.7)	2	(2.0)	0.326
Hepatic vein complication	24	(8.8)	15	(14)	0.126
Portal vein complication	27	(9.9)	24	(23)	0.001	1.85	(0.95-3.59)	0.070
Bile duct complication	16	(5.9)	5	(4.7)	0.657
Cytomegalovirus infection	161	(59)	61	(58)	0.771
Epstein–Barr virus infection	187	(69)	72	(68)	0.839
Acute cellular rejection	127	(47)	59	(56)	0.117

¹Mann–Whitney U test, χ² test, or Fisher's exact test.

BSI: Blood stream infection; DDLT: Deceased donor liver transplantation; IQR: Interquartile range; MELD: Model for End-Stage Liver Disease; OR: Odds ration; PELD: Pediatric End-Stage Liver Disease; LT: Liver transplantation.