Infections Within the First Month After Pediatric Lung Transplantation: Epidemiology and Impact on Outcomes

• Published in: Journal of the Pediatric Infectious Diseases Society Vol. 10; no. 3; pp. 245 - 251
• Main Authors: Onyearugbulem, Chinyere, Coss-Bu, Jorge, Gazzaneo, Maria C, Melicoff, Ernestina, Das, Shailendra, Lam, Fong, Mallory, George B, Munoz, Flor M
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 03-04-2021
• Subjects: epidemiology; pediatric lung transplant; infection; outcomes
• ISSN: 2048-7207; 2048-7207
• DOI: 10.1093/jpids/piaa050

Abstract
Background
Despite successes in lung transplantation, with infection as the leading cause of death in the first year following lung transplantation, there remains a lag in survival compared with other solid organ transplants. Infections that occur early after transplantation may impact short- and long-term outcomes in pediatric lung transplant recipients (LTRs).
Methods
We performed a retrospective review of pediatric LTRs at a large quaternary-care hospital from January 2009 to March 2016 to evaluate both epidemiologic features of infection in the first 30 days post-transplantation and mortality outcomes. The 30 days were divided into early (0–7 days) and late (8–30 days) periods.
Results
Among the 98 LTRs, there were 51 episodes of infections. Cystic fibrosis (CF) was associated with early bacterial infections (P = .004) while non-CF was associated with late viral (P = .02) infections. Infection after transplantation was associated with worse survival by Kaplan-Meier analysis (P value log rank test = .007). Viral infection in the late period was significantly associated with 3-year mortality after multivariable analysis (P = .02).
Conclusions
Infections in pediatric LTRs were frequent in the first 30 days after transplant, despite perioperative antimicrobial coverage. The association of 3-year mortality with late viral infections suggests a possible important role in post-transplant lung physiology and graft function. Understanding the epidemiology of early post-lung transplant infections can help guide post-operative management and interventions to reduce their incidence and the early- and long-term impact in this population.
In our evaluation of the epidemiologic features of infections in the first 30 days following pediatric lung transplantation, we found a high incidence of infection despite targeted antimicrobial therapy, with viral infections on days 8 through 30 associated with 3-year mortality.