Bloodstream Infections Common After Pediatric Liver Transplant

Male pediatrician pressing stomach of girl during checkup. Female child is lying on examination table in clinic. They are in hospital during coronavirus outbreak.
A team of researchers assessed the risk factors and pathogens associated with bloodstream infection 1 year after pediatric liver transplantation.

Bloodstream infections (BSIs) occurred among more than a quarter of children who received liver transplantation (LT) and affected survival outcomes, according to results of a study published in the World Journal of Gastroenterology.

For the analysis, researchers retrospectively reviewed primary pediatric LT (N=378) at the Asan Medical Center in South Korea between 1994 and 2020. Clinical outcomes were evaluated on the basis of BSI during the first year after transplantation.

The study cohort included children with a median age of 1.58 (IQR, 0.83-5.42) years, 53% were girls, 25% had growth failure, 76% received a living donation, 53% received a transplant due to biliary atresia, 23% for acute liver failure, 12% for metabolic failure, 6.6% for malignancy, and 5.3% for other indications.

Few patients (1.1%) had surgical complications. A total of 50 (13%) required reoperation within 2 months of primary LT.

During the first year after transplant, 28% experienced a pathogen-confirmed BSI, onsetting at a median of 0.4 (IQR, 0.03-1.3) months. Among the BSI cohort, 67% had a single episode and 33% multiple episodes (mean, 1.53±0.95 episodes).

The most common culprit BSI organism was coagulase-negative staphylococci (38%), followed by Enterococcus spp. (12%) and Streptococcus spp (10%). Half (53%) of infections were of unknown origin, 37% were catheter-related, and 6% were of intraabdominal origin.

The survival rates of patients who had a BSI vs no BSI at 1 (86% vs 95%), 5 (77% vs 92%), and 10 (76% vs 88%) years were significantly lower (P <.001).

BSI risk was associated with need for liver support system (odds ratio [OR], 4.2; 95% CI, 1.45-12.09; P =.008), post-LT hospital stay longer than 44 days (OR, 2.3; 95% CI, 1.35-3.91; P =.002), age 1.3 years or younger (OR, 2.1; 95% CI, 1.18-3.77; P =.011), and growth failure status (OR, 2.1; 95% CI, 1.01-4.47; P =.045). These risk factors had an area under the curve (AUC) of 0.744 for predicting BSI.

The study was limited by its single-center design, and the findings may not be generalizable.

These data indicated that BSI was relatively common within the first year of primary LT among children and that occurrence of BSIs associated with significant reductions in survival.

“The profile of the pathogens, onset, and origin site of BSI may be informative to establish individual policy in each surgery center against BSI after the transplant,” the study authors wrote. “As clinical practices in pediatric LTs continue to advance, further investigation is necessary to identify how risk factors have been altered by the dynamic nature of early post-LT care and to seek actionable changes in LT care.”


Kim YE, Choi HJ, Lee H-J, et al. Assessment of pathogens and risk factors associated with bloodstream infection in the year after pediatric liver transplantation. World J Gastroenterol. Published online March 21, 2022. doi:10.3748/wjg.v28.i11.1159