Korean J Transplant.  2023 Nov;37(Suppl 1):S49. 10.4285/ATW2023.F-6148.

Epidemiology of invasive fungal infection in pediatric liver transplant recipients: a retrospective single-center study 2012–2022

• Lee JY
• Ihn K
• Koh H
• Kim MS
• Kang JM

• KMID: 2551636
• DOI: http://doi.org/10.4285/ATW2023.F-6148

Abstract

Background
The incidence of invasive fungal infection (IFI) in pediatric liver transplant (LT) recipients ranges from 2.5 to 5%; however, antifungal prophylaxis has not yet been approved in Korea. We investigated the incidence of early-onset IFI and its characteristics in pediatric LT recipients in Korea, and also explored its risk factors.
Methods
This is a retrospective, single-center study on children (<19 years of age) who have undergone LT from 2012 to 2022 at Severance Hospital, Korea. IFI was defined as detection of fungus in sterile fluid or tissue and/or blood associated with symptoms. Superficial fungal infection and colonization on the skin or urine were excluded. The primary outcome is the occurrence of IFI within 90 days from LT. The logistic regression was used to analyze the risk factors of IFI.
Results
A total of 104 LT children and 111 cases were included. 42.3% (n=44) were male, and the median age at LT was 4.0 years of age (interquartile range [IQR], 1.0–11.0). Two thirds received LT due to biliary atresia (n=69, 66.3%). Antifungal prophylaxis was not done in 86.5% of the LT recipients. Twenty-three IFI events was identified in 19 patients (18.3%) at median time of 16.5 days after LT (IQR, 10–38). 87.0% of the pathogens detected were Candida species (C.albicans 40.0%, C.parapsilosis 35.0%, C. auris 15.0%), and Aspergillus fumigatus (13.0%). The risk of IFI was significantly increased in those who underwent retransplantation, postoperative intervention or surgery due to bleeding, vascular, and bile duct complications (odd ratio [OR], 4.6; 95% confidence interval [CI], 1.54–13.60; P=0.006), and postoperative renal replacement therapy (OR, 3.2; 95% CI, 1.13–8.82; P=0.028).
Conclusions
The incidence of early IFI after LT in Korean children is considerable; therefore, universal antifungal prophylaxis, especially in high-risk IFI patients such as reoperation or intervention and renal replacement therapy, is necessary.