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Risk factors for early invasive fungal infections in paediatric liver transplant recipients
Author(s) -
Pasternak Yehonatan,
Rubin Shiri,
Bilavsky Efraim,
MozerGlassberg Yael,
Levy Itzhak,
Nahum Elhanan,
Rom Eran,
Gurevich Michael,
BenZvi Haim,
AshkenaziHoffnung Liat
Publication year - 2018
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12784
Subject(s) - medicine , liver transplantation , transplantation , incidence (geometry) , population , risk factor , complication , intensive care medicine , surgery , physics , environmental health , optics
Summary Invasive fungal infections ( IFI s) postliver transplantation are a frequent cause of morbidity and mortality; however, studies reporting on these infections in the paediatric population are scarce. To investigate the incidence and risk factors of IFI s in paediatric liver transplant recipients during the early posttransplantation period (≤3 months). Data were collected for all paediatric liver transplant recipients registered in a national transplantation center from 2004 to 2014. Using a stepwise logistic regression to identify independent risk factors for IFI s, a predictive model was formulated. Ten IFI s were identified in 81 liver transplant recipients (12.3%) all occurring during the first month posttransplantation. Candida species were responsible for nine cases (90%), of which four were non‐albicans Candida (44%). Significant risk factors were identified; recipient of multiple blood product transfusions during transplantation, prolonged use of indwelling intravenous catheter, prolonged IV antibiotic treatment, surgical complications, pulse steroid treatment and living donor liver transplantation. The predictive model used two clinical parameters to define high‐risk patients: a living donor transplantation and duration of IV antibiotic treatment (area under the ROC curve 0.918). IFI s are a significant complication occurring in the first month posttransplantation. Future studies are required to assess efficacy of targeted antifungal prophylaxis in high risk patients.