|
1
|
Gerthoffer E, Pozderac A, Darland L, Yasechko S, Crooker A, Hambrick HR, Danziger-Isakov L. Association of Neutropenia With Valganciclovir Prophylaxis Dosing Practices Within Pediatric Solid Organ Transplant Recipients. Pediatr Transplant 2025; 29:e70098. [PMID: 40318129 DOI: 10.1111/petr.70098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2025] [Revised: 04/22/2025] [Accepted: 04/25/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Prophylactic dosing of valganciclovir for cytomegalovirus prophylaxis in the pediatric solid organ transplant (SOT) population is highly variable among institutions. The purpose of this study was to assess the impact of valganciclovir dosing strategy on neutropenia in SOT recipients at a pediatric academic medical center utilizing a novel method of GFR estimation. METHODS A retrospective chart review was conducted to identify differences between patients with and without neutropenia. Regression modeling was used to determine whether valganciclovir dosing strategy could predict posttransplant neutropenia. RESULTS Of 80 patients included in the study, 32.5% were neutropenic while prescribed valganciclovir. Most patients were receiving concomitant myelosuppressive medications (sulfamethoxazole-trimethoprim [87.5%] and mycophenolate [66.3%]). Fourteen (53.8%) and 21 (38.9%) patients' doses were determined using their cystatin C-based estimated GFR in the neutropenic and non-neutropenic groups, respectively (p = NS). Rates of CMV DNAemia were < 5% in both groups. Valganciclovir dose was not predictive of the rate, odds, or degree of neutropenia. However, a higher valganciclovir dose adjusted for kidney function was associated with a higher log odds of neutropenia. CONCLUSIONS At our institution, where BSA-based dosing using a novel GFR method and appropriate upper limits of GFR for age is used, the rate of neutropenia was lower than previous reports in the literature. Furthermore, valganciclovir dose in milligrams per kilogram was not associated with an increased odds or degree of neutropenia. However, dose accounting for BSA and kidney function was. It is crucial to consider kidney function and the exposure to valganciclovir (vs. dose alone) when determining the risk of neutropenia.
Collapse
Affiliation(s)
- Emma Gerthoffer
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amber Pozderac
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Leanna Darland
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stephanie Yasechko
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna Crooker
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - H Rhodes Hambrick
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Translational and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Nephrology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lara Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
|
2
|
Yazdanpanah S, Shafiekhani M, Zare Z, Nikoupour H, Geramizadeh B, Chamanpara P, Jabrodini A, Ahmadi M, Malekizadeh Z, Anbardar MH, Pakshir K, Zomorodian K. Species distribution and antifungal susceptibility patterns of Candida involvement in pediatric solid organ transplant recipients: A cross-sectional study from a single transplant center. J Mycol Med 2025; 35:101522. [PMID: 39631202 DOI: 10.1016/j.mycmed.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 10/21/2024] [Accepted: 11/15/2024] [Indexed: 12/07/2024]
Abstract
The epidemiology and resistance patterns of Candida infections in pediatric kidney/liver recipients has not been well characterized, recently. In this study, all patients ≤ 18 years old who underwent liver/kidney transplant surgery between September 2021 and 2022 were included. Species identification of isolates recovered from clinical specimens was performed by DNA-sequencing method following amplification of the ITS1-5.8S-ITS2 regions. Antifungal susceptibility patterns of isolates were performed using the micro broth dilution method documented by Clinical & Laboratory Standards Institute (CLSI) guidelines. Of the 117 pediatric recipients enrolled, 16 recipients (13.7 %) had at least one positive Candida culture. Candidemia was detected in 5/89 (5.6 %) of liver and 1/28 (3.6 %) of kidney transplant recipients. Invasive candidiasis was observed in 6/89 (6.7 %) of liver and 2/28 (7.1 %) of kidney transplant recipients. The predominant species was Candida (C.) albicans recovered from 12 of 16 recipients (75 %). In addition to the Pichia kudriavzevii species with inherent resistance to fluconazole, one of C. albicans isolates and one C. tropicalis isolate were also identified as fluconazole-resistant (3/29:10.3 %). Moreover, our findings revealed 13.8 % and 6.8 % resistance to itraconazole and voriconazole, respectively. All Candida spp. were susceptible to caspofungin. Collectively, this study provides valuable insights into the epidemiology and resistance patterns of Candida infections in pediatric kidney and liver recipients. The study also highlights the emergence of fluconazole-resistant strains, which has significant implications for antifungal stewardship efforts in pediatric transplant populations.
Collapse
Affiliation(s)
- Somayeh Yazdanpanah
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Zare
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Nikoupour
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Chamanpara
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Jabrodini
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ahmadi
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Malekizadeh
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Anbardar
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Pakshir
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
|
3
|
Shieb M, Hasanain R, Arshad Z, Nawaz FA, Kashyap R, Stern EJ. Incidence, causative organisms, and risk factors of bloodstream infections in pediatric liver transplant patients: a systematic review. Clin Exp Pediatr 2024; 67:427-434. [PMID: 38605664 PMCID: PMC11374452 DOI: 10.3345/cep.2023.01466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 04/13/2024] Open
Abstract
Bacterial bloodstream infections (BSI) are the leading cause of mortality and morbidity in pediatric solid organ transplant recipients. This systematic review aimed to pool global data from leading transplant institutions and identify the overall incidence, risk factors, and causative organisms of BSI in pediatric liver transplant recipients. A systematic review of the PubMed and OVID databases was conducted from 2000 to 2022. The initial search yielded 252 unique articles, which were independently reviewed by 2 authors. Articles that reported pediatric-specific data on BSI in isolated liver transplant patients were included, including the incidence of BSI, isolated organisms, and involved risk factors involved. This systematic review was registered with PROSPERO (ID: CRD42023403206). Fourteen articles from the United States, France, Iran, Japan, Korea, South Africa, Thailand, and Turkey were included. A total of 4,812 liver transplants were included in the final analysis. The mean patient age was 25 months (age range, 0-18 years), and 50.9% were male. The overall incidence of BSI was 23.5% (range, 14.7%-55%). The most commonly reported organisms were Staphylococcus epidermidis, Enterococcus, Klebsiella spp., and Escherichia coli. Among the risk factors studied, postope rative biliary complications, a medical history of biliary atresia, and younger age were the risk factors most commonly associated with BSI. Bacterial BSI after pediatric liver transplantation occur at a high incidence, with a unique organism profile notable for a higher percentage of gram-negative organisms. Further studies are required to determine the most appropriate prophylactic and empirical antibiotic management strategies for this population.
Collapse
Affiliation(s)
- Mohamad Shieb
- Medstar Georgetown University Hospital, Washington, DC, USA
| | | | - Zara Arshad
- Shifa Clinical Research Center, Islamabad, Pakistan
| | | | | | - Eric J. Stern
- Medstar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
|
4
|
Kitt E, Stephens-Shields AJ, Huang YSV, Bittermann T, Fisher BT. Comparative Effectiveness of Perioperative Antibiotic Regimens to Prevent Surgical Site Infections in Pediatric Liver Transplant Recipients. Clin Infect Dis 2024; 79:263-270. [PMID: 38381580 DOI: 10.1093/cid/ciae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are a common complication in liver transplant (LT) recipients. Lack of pediatric prophylaxis guidelines results in variation in preventative antibiotic regimens. METHODS We performed a retrospective observational study of LT recipients <18 years old using a merged data set that included data from the Pediatric Health Information System and the United Network for Organ Sharing between 2006 and 2017. The exposure was defined as the antibiotic(s) received within 24 hours of LT, with 6 categories, ranging from narrow (category 1: cefazolin), to broad). The primary outcome was presence or absence of SSI in the index admission. Mixed-effects logistic regression compared the effectiveness of each category in preventing SSI, relative to category 1. RESULTS Of the 2586 LT, 284 (11%) met SSI criteria. The SSI rate was higher in the younger subcohort (16.2%) than in the older (8.6%), necessitating a stratified analysis. Antibiotics from category 5 were most commonly used. In the younger subcohort, the adjusted risk was increased in all categories compared with the reference, most notably in category 3 (odds ratio [OR], 2.58 [95% confidence interval: .69-9.59]) and category 6 (2.76 [.66-11.56]). In the older subcohort, estimated ORs were also increased for each category, most notably in category 4 (2.49 [95% confidence interval: .99-6.27]). None of the ORs suggested benefit from broader-spectrum prophylaxis. Our E-value assessment suggests that it's unlikely there is unmeasured confounding by indication to the degree necessary to revert ORs to protective. CONCLUSIONS There was wide variation in antibiotic prophylaxis. Adjusted analyses did not reveal a protective benefit of broader-spectrum prophylaxis in either subcohort, suggesting that narrower regimens may be adequate.
Collapse
Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases in the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Paediatrics, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Alisa J Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuan-Shung Vera Huang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology, Hepatology & Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian T Fisher
- Division of Infectious Diseases in the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
|
5
|
Walabh P, Moore DP, Paget G, Meyer A, Moshesh PNM, Walabh P, Palweni ST, Hajinicolaou C. Healthcare disparity and its associations with cytomegalovirus disease in pediatric liver transplant recipients in South Africa. Transpl Infect Dis 2022; 24:e13917. [PMID: 35870126 PMCID: PMC10078342 DOI: 10.1111/tid.13917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection and disease are preventable complications following pediatric liver transplantation (PLT), despite the use of prophylaxis to minimize the risk of CMV disease. We evaluated the incidence and complications of CMV disease in PLT recipients in South Africa (SA), with particular reference to potential differences in outcome between state and private sector patients. METHODS Medical records of patients younger than 16 years of age who received liver transplants between January 1, 2012, and August 31, 2018 were analyzed. RESULTS Records of all 150 PLT patients were retrieved. The median age at transplant was 29.2 months (95% confidence interval 15.6-58.4) and follow-up was 46.3 months (interquartile range 27.6-63.1). Sixty-six (44%) patients were high risk, 79 (52.7%) were intermediate risk, and five (3.3%) were low risk for CMV infection. Forty-three (28.9%) patients had CMV DNAemia following transplantation, and 30 (20.1%) developed CMV disease. Receipt of care in the private sector was consistently associated with a lower hazard of CMV disease (adjusted hazard ratio [aHR] ranging from 0.36 to 0.43) and a consistently lower hazard of death among recipients at high risk for CMV disease and/or those who developed CMV disease (aHR ranging from 0.28 to 0.33). CONCLUSION Receipt of care in the private health sector was associated with a consistently lower hazard of CMV disease and death in individuals with CMV disease and/or at high risk for CMV disease. Policies aimed at creating a more equitable healthcare system in SA may mitigate the differential burden of illness associated with CMV in PLT recipients.
Collapse
Affiliation(s)
- Priya Walabh
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Paediatric Gastroenterology and Hepatology Unit, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand, Johannesburg, South Africa.,Gauteng Provincial Solid Organ Transplant Division, Gauteng, South Africa
| | - David P Moore
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa.,Medical Research Council, Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Graham Paget
- Gauteng Provincial Solid Organ Transplant Division, Gauteng, South Africa.,Division of Nephrology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Anja Meyer
- Gauteng Provincial Solid Organ Transplant Division, Gauteng, South Africa.,Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Porai Nthabaleng M Moshesh
- School of Clinical Medicine, Faculty of Health Sciences, Paediatric Intensive Care Unit, Nelson Mandela Children's Hospital, University of Witwatersrand, Johannesburg, South Africa
| | | | - Sechaba T Palweni
- Gauteng Provincial Solid Organ Transplant Division, Gauteng, South Africa.,Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.,Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Christina Hajinicolaou
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa.,Divisional Head Paediatric Gastroenterology, Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
|
6
|
Incidence, Clinicomicrobiological Characteristics, Risk Factors, and Treatment Outcomes of Bacterial Infections Following Liver Transplantation in Pediatrics: A Retrospective Cohort Study. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2022. [DOI: 10.5812/pedinfect-118809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Liver transplantation (LT) is the definitive treatment for patients with advanced liver failure. Bacterial infections are common consequences of organ transplantation resulting from immune suppression and prolonged hospitalization. Methods: This retrospective cohort study examined the records of all liver transplant pediatrics under 18 years of age in Abu-Ali Sina hospital, Shiraz, Fars province, Iran, from April 2019 to February 2020. Demographic, laboratory, and clinical data were extracted along with the administered therapeutic approach for the patient. Results: Of 80 enrolled patients, 52 were male, and 28 were female, with a median age of 60 months. An incidence of 67.9% of bacterial infections was recorded. Gram-negative and Gram-positive pathogens accounted for 64.06% and 35.93% of infections, respectively. Surgical site infections were the most common ones. The length of ICU stay, hospitalization, mechanical ventilation duration, and re-hospitalization were significantly higher in the infected group than in non-infected pediatrics (P-value < 0.05). Multivariate regression analysis showed that the only risk factor for bacterial infections after LT was the length of ICU stay. The mortality rate was 22%, which was significantly higher among the infection group (P = 0.008). Conclusions: A high rate of bacterial infections and an increasing prevalence of nosocomial and antibiotic-resistant pathogens were detected in the early period after LT.
Collapse
|
|
7
|
Kim YE, Choi HJ, Lee HJ, Oh HJ, Ahn MK, Oh SH, Namgoong JM, Kim DY, Jhang WK, Park SJ, Jung DH, Moon DB, Song GW, Park GC, Ha TY, Ahn CS, Kim KH, Hwang S, Lee SG, Kim KM. Assessment of pathogens and risk factors associated with bloodstream infection in the year after pediatric liver transplantation. World J Gastroenterol 2022; 28:1159-1171. [PMID: 35431506 PMCID: PMC8985487 DOI: 10.3748/wjg.v28.i11.1159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/20/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bloodstream infection (BSI) is one of the most significantly adverse events that can occur after liver transplantation (LT) in children.
AIM To analyze the profile of BSI according to the postoperative periods and assess the risk factors after pediatric LT.
METHODS Clinical data, collected from medical charts of children (n = 378) who underwent primary LT, were retrospectively reviewed. The primary outcome considered was BSI in the first year after LT. Univariate and multivariate analyses were performed to identify risk factors for BSI and respective odds ratios (ORs).
RESULTS Of the examined patients, 106 (28%) experienced 162 episodes of pathogen-confirmed BSI during the first year after LT. There were 1.53 ± 0.95 episodes per children (mean ± SD) among BSI-complicated patients with a median onset of 0.4 mo post-LT. The most common pathogenic organisms identified were Coagulase-negative staphylococci, followed by Enterococcus spp. and Streptococcus spp. About half (53%) of the BSIs were of unknown origin. Multivariate analysis demonstrated that young age (≤ 1.3 year; OR = 2.1, P = 0.011), growth failure (OR = 2.1, P = 0.045), liver support system (OR = 4.2, P = 0.008), and hospital stay of > 44 d (OR = 2.3, P = 0.002) were independently associated with BSI in the year after LT.
CONCLUSION BSI was frequently observed in patients after pediatric LT, affecting survival outcomes. The profile of BSI may inform clinical treatment and management in high-risk children after LT.
Collapse
Affiliation(s)
- Yeong Eun Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Ho Jung Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Hye-Jin Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Hyun Ju Oh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Mi Kyoung Ahn
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jung-Man Namgoong
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Dae Yeon Kim
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Seong Jong Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Deok Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Sung Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, South Korea
| |
Collapse
|
|
8
|
Bansal N, Ovchinsky N, Foca M, Lamour JM, Kogan‐Liberman D, Hsu DT, Beddows K, Abraham L, Coburn M, Cunningham R, Nguyen T, Hayde N. COVID-19 infection in pediatric solid organ transplant patients. Pediatr Transplant 2022; 26:e14156. [PMID: 34633125 PMCID: PMC8646513 DOI: 10.1111/petr.14156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adult SOT recipients with COVID-19 have higher mortality rates when compared to general population. There is paucity of data on outcomes in pediatric SOT recipients. METHODS This is a cross-sectional study investigating the prevalence of COVID-19 infection and outcomes in pediatric SOT (heart, liver, and kidney) recipients. We extracted demographic and clinical characteristics and COVID-19 testing (PCR or [Ab] test) results from medical records. Clinical characteristics were compared between patients who were positive for COVID-19 (PCR or Ab) and those who did not, using Mann-Whitney, Student's t test, or chi-square test. p value <.05 was statistically significant. RESULTS A total of 108 SOT recipients with a median age of 13.1 (8.4, 17.8) years and median 4.2 (2.7, 7.9) years from transplant were checked for COVID-19 via a PCR or Ab test. A positive PCR was confirmed in 10 patients (9.3%), while 12 patients (11.1%) were positive for COVID-19 Ab. The patients who tested positive in our cohort were 9/50 (18%) heart, 6/68 (8.8%) kidney, and 7/50 (14%) liver transplant recipients. There were no differences in the clinical characteristics between patients with and without COVID-19 infection. All patients were either asymptomatic (50%) or had self-limiting symptoms. No changes were made to the immunosuppressive regimen. Only one patient was hospitalized and none had an oxygen requirement. CONCLUSIONS In our cohort of pediatric SOT recipients, COVID-19 infection was asymptomatic or mild. This data may aid clinicians in counseling patients and families in this increased-risk population.
Collapse
Affiliation(s)
- Neha Bansal
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Nadia Ovchinsky
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Marc Foca
- Division of Pediatric Infectious DiseasesChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Jacqueline M. Lamour
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Debora Kogan‐Liberman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Daphne T. Hsu
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Kimberly Beddows
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Lincy Abraham
- Division of Pediatric CardiologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Maura Coburn
- Division of Pediatric NephrologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| | - Ryan Cunningham
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Trang Nguyen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition Children’s Hospital at MontefioreBronxNew YorkUSA
| | - Nicole Hayde
- Division of Pediatric NephrologyChildren’s Hospital at MontefioreBronxNew YorkUSA
| |
Collapse
|
|
9
|
Valencia Deray KG, Hosek KE, Chilukuri D, Dunson JR, Spielberg DR, Swartz SJ, Spinner JA, Leung DH, Moulton EA, Munoz FM, Demmler-Harrison GJ, Bocchini CE. Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients. Am J Transplant 2022; 22:187-198. [PMID: 34467658 DOI: 10.1111/ajt.16822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/08/2021] [Accepted: 08/28/2021] [Indexed: 01/25/2023]
Abstract
Despite prevention strategies, cytomegalovirus (CMV) remains a common infection in pediatric solid organ transplant recipients (SOTR). We sought to determine the frequency, associations with, and long-term outcomes of CMV DNAemia in pediatric SOTR. We performed a single-center retrospective cohort study, including 687 first time SOTR ≤21 years receiving universal prophylaxis from 2011 to 2018. Overall, 159 (23%) developed CMV DNAemia, the majority occurring after completing primary prophylaxis. CMV disease occurred in 33 (5%) SOTR, 25 (4%) with CMV syndrome and 10 (1%) with proven/probable tissue-invasive disease. CMV contributed to the death of three (0.4%) patients (all lung). High-risk (OR 6.86 [95% CI, 3.6-12.9]) and intermediate-risk (4.36 [2.3-8.2]) CMV status and lung transplantation (4.63 [2.33-9.2]) were associated with DNAemia on multivariable analysis. DNAemia was associated with rejection in liver transplant recipients (p < .01). DNAemia was not associated with an increase in graft failure, all-cause mortality, or other organ-specific poor outcomes. We report one of the lowest rates of CMV disease after SOTR, showing that universal prophylaxis is effective and should be continued. However, we observed CMV morbidity and mortality in a subset of patients, highlighting the need for research on optimal prevention strategies. This study was IRB approved.
Collapse
Affiliation(s)
- Kristen G Valencia Deray
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Kathleen E Hosek
- Department of Pediatrics, Section of Quality, Texas Children's Hospital, Houston, Texas, USA
| | - Divya Chilukuri
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jordan R Dunson
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - David R Spielberg
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah J Swartz
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph A Spinner
- Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel H Leung
- Department of Pediatrics, Section of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth A Moulton
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Gail J Demmler-Harrison
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Claire E Bocchini
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
|
10
|
Yuksel M, Akturk H, Mizikoglu O, Toroslu E, Arikan C. A single-center report of COVID-19 disease course and management in liver transplanted pediatric patients. Pediatr Transplant 2021; 25:e14061. [PMID: 34076953 PMCID: PMC8237072 DOI: 10.1111/petr.14061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND In 2019, SARS-CoV-2 causing COVID-19 emerged. Severe COVID-19 symptoms may evolve by virtue of hyperactivation of the immune system. Equally, immunocompromised patients may be at increased risk to develop COVID-19. However, treatment guidelines for children following liver transplantation are elusive. METHODS As a liver transplantation center, we diagnosed and followed up 10 children (male/female: 8/2) with a median age of 8.5 years (IQR: 5.2-11.0), with COVID-19 post-liver transplant between March 2019 and December 2020. COVID-19 diagnosis was based on PCR test and or florid X-ray findings compatible with COVID-19 in the absence of other cause. We retrospectively collected clinical and laboratory data from electronic patient records following written consent from patients/parents. RESULTS Nine patients were diagnosed as definitive (PCR positive) with one patient being diagnosed as probable COVID-19. Seven patients recovered without any support whereas three were admitted for non-invasive oxygenation. Lymphopenia and/or high levels of serum IL-6 were detected in four patients. Six patients mounted anti-SARS-CoV-2 antibodies at median 30 days (IQR: 26.5-119.0) following COVID-19 diagnosis. Antibiotic therapy, favipiravir, anakinra, and IVIG were used as treatment in 4,1,1 and 2 patients, respectively. Furthermore, we kept the tacrolimus with or without everolimus but stopped MMF in 2 patients. Importantly, liver allograft function was retained in all patients. CONCLUSIONS We found that being immunocompromised did not affect disease severity nor survival. Stopping MMF yet continuing with tacrolimus was an apt treatment modality in these patients.
Collapse
Affiliation(s)
- Muhammed Yuksel
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey,Koç University Research Center for Translational Medicine (KUTTAM)‐Liver Immunology LabIstanbulTurkey
| | - Hacer Akturk
- Koç University Pediatric infectious diseasesIstanbulTurkey
| | - Ozlem Mizikoglu
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey
| | - Ertug Toroslu
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey
| | - Cigdem Arikan
- Pediatric Gastroenterology‐HepatologyLiver Transplantation CenterKoç University HospitalIstanbulTurkey,Koç University Research Center for Translational Medicine (KUTTAM)‐Liver Immunology LabIstanbulTurkey
| |
Collapse
|
|
11
|
Onyearugbulem C, Coss-Bu J, Gazzaneo MC, Melicoff E, Das S, Lam F, Mallory GB, Munoz FM. Infections Within the First Month After Pediatric Lung Transplantation: Epidemiology and Impact on Outcomes. J Pediatric Infect Dis Soc 2021; 10:245-251. [PMID: 32533840 DOI: 10.1093/jpids/piaa050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/24/2020] [Indexed: 11/14/2022]
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.
Collapse
Affiliation(s)
- Chinyere Onyearugbulem
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Houston, Texas
| | - Jorge Coss-Bu
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Houston, Texas
| | - Maria C Gazzaneo
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Pulmonary Medicine, Texas Children's Hospital, Houston, Texas
| | - Ernestina Melicoff
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Pulmonary Medicine, Texas Children's Hospital, Houston, Texas
| | - Shailendra Das
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Pulmonary Medicine, Texas Children's Hospital, Houston, Texas
| | - Fong Lam
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Houston, Texas
| | - George B Mallory
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Pulmonary Medicine, Texas Children's Hospital, Houston, Texas
| | - Flor M Munoz
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
|
12
|
Dubois M, Dixit A, Lamb G. Tuberculosis in Pediatric Solid Organ and Hematopoietic Stem Cell Recipients. Glob Pediatr Health 2021; 8:2333794X20981548. [PMID: 33506075 PMCID: PMC7812398 DOI: 10.1177/2333794x20981548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
Children undergoing solid organ and hematopoietic stem cell transplantation are at high risk of morbidity and mortality from tuberculosis (TB) disease in the post-transplant period. Treatment of TB infection and disease in the post-transplant setting is complicated by immunosuppression and drug interactions. There are limited data that address the unique challenges for the management of TB in the pediatric transplant population. This review presents the current understanding of the epidemiology, clinical presentation, diagnosis, management, and prevention for pediatric transplant recipients with TB infection and disease. Further studies are needed to improve diagnosis of TB and optimize treatment outcomes for these patients.
Collapse
Affiliation(s)
- Melanie Dubois
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Avika Dixit
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gabriella Lamb
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
13
|
Katz DT, Torres NS, Chatani B, Gonzalez IA, Chandar J, Miloh T, Rusconi P, Garcia J. Care of Pediatric Solid Organ Transplant Recipients: An Overview for Primary Care Providers. Pediatrics 2020; 146:peds.2020-0696. [PMID: 33208494 DOI: 10.1542/peds.2020-0696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
Abstract
As the number of living pediatric solid organ transplant (SOT) recipients continues to grow, there is an increased likelihood that primary care providers (PCPs) will encounter pediatric SOT recipients in their practices. In addition, as end-stage organ failure is replaced with chronic medical conditions in transplant recipients, there is a need for a comprehensive approach to their management. PCPs can significantly enhance the care of immunosuppressed hosts by advising parents of safety considerations and avoiding adverse drug interactions. Together with subspecialty providers, PCPs are responsible for ensuring that appropriate vaccinations are given and can play an important role in the diagnosis of infections. Through early recognition of rejection and posttransplant complications, PCPs can minimize morbidity. Growth and development can be optimized through frequent assessments and timely referrals. Adherence to immunosuppressive regimens can be greatly improved through reinforcement at every encounter, particularly among adolescents. PCPs can also improve long-term outcomes by easing the transition of pediatric SOT recipients to adult providers. Although guidelines exist for the primary care management of adult SOT recipients, comprehensive guidance is lacking for pediatric providers. In this evidence-based overview, we outline the main issues affecting pediatric SOT recipients and provide guidance for PCPs regarding their management from the first encounter after the transplant to the main challenges that arise in childhood and adolescence. Overall, PCPs can and should use their expertise and serve as an additional layer of support in conjunction with the transplant center for families that are caring for a pediatric SOT recipient.
Collapse
Affiliation(s)
- Daphna T Katz
- Holtz Children's Hospital, Jackson Health System, Miami, Florida.,Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida; and
| | - Nicole S Torres
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida; and
| | | | | | - Jayanthi Chandar
- Pediatric Nephrology.,Miami Transplant Institute, Miami, Florida
| | - Tamir Miloh
- Miami Transplant Institute, Miami, Florida.,Pediatric Gastroenterology, and
| | - Paolo Rusconi
- Miami Transplant Institute, Miami, Florida.,Pediatric Cardiology
| | - Jennifer Garcia
- Miami Transplant Institute, Miami, Florida .,Pediatric Gastroenterology, and
| |
Collapse
|
|
14
|
Londeree J, Winterberg PD, Garro R, George RP, Shin S, Liverman R, Serluco A, Romero R, Yildirim I. Brincidofovir for the treatment of human adenovirus infection in pediatric solid organ transplant recipients: A case series. Pediatr Transplant 2020; 24:e13769. [PMID: 32558134 DOI: 10.1111/petr.13769] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
Abstract
HAdV viremia can cause significant morbidity among pediatric recipients of SOT with variability in incidence and severity of disease based on the type of allograft. Currently, there are no US FDA-approved treatments for HAdV infections, and historically, the mainstay of treatment has been decreasing immunosuppression, with antiviral therapies reserved for those with severe disease. We describe the treatment of four pediatric SOT recipients (two kidney, one combined kidney-liver, and one liver) presenting with HAdV disease at our institution using brincidofovir. Our case series highlights the variability in presentation and the potential for severe disease in pediatric SOT recipients as we review disease presentation, disease course, complications, and treatment with brincidofovir.
Collapse
Affiliation(s)
- Jackson Londeree
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Pamela D Winterberg
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Rouba Garro
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Roshan P George
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Stella Shin
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Rene Romero
- Division of Hepatology and Gastroenterology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Inci Yildirim
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
| |
Collapse
|
|
15
|
Nikoupour H, Kazemi K, Arasteh P, Ghazimoghadam S, Eghlimi H, Dara N, Gholami S, Nikeghbalian S. Pediatric liver transplantation and COVID-19: a case report. BMC Surg 2020; 20:224. [PMID: 33023552 PMCID: PMC7538038 DOI: 10.1186/s12893-020-00878-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background Immunosuppressed patients, including individuals with organ transplantation, have been among susceptible groups with regard to COVID-19, on the other hand pediatric patients more commonly undergo a mild clinical course after acquiring COVID-19. To the best of the authors knowledge, to this date very little data exists on COVID-19 in a pediatric patient with liver transplantation. Case presentation We report a three year-old boy who had liver transplantation at 18 months old. He was admitted due to dyspnea with impression of acute respiratory distress syndrome and was then transferred to the intensive care unit. Chest X-ray at admission showed bilateral infiltration. Vancomycin, meropenem, azithromycin, voriconazole and co-trimoxazole were started from the first day of admission. On day 4 of admission, with suspicion of COVID-19, hydroxychloroquine, lopinavir/ritonavir and oseltamivir were added to the antibiotic regimen. PCR was positive for COVID-19. The patient developed multi-organ failure and died on day 6 of admission. Conclusions For pediatric patients with organ transplantations, extreme caution should be taken, to limit and prevent their contact with COVID-19 during the outbreak, as these patients are highly susceptible to severe forms of the disease.
Collapse
Affiliation(s)
- Hamed Nikoupour
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saba Ghazimoghadam
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hesameddin Eghlimi
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naghi Dara
- Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siavash Gholami
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Nikeghbalian
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
|
16
|
Duncan M, DeVoll-Zabrocki A, Etheredge HR, Maher HA, Bouter C, Gaylard P, Loveland J, Fabian J, Botha JF. Blood stream infections in children in the first year after liver transplantation at Wits Donald Gordon Medical Centre, South Africa. Pediatr Transplant 2020; 24:e13660. [PMID: 31985168 DOI: 10.1111/petr.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Children who undergo liver transplantation and subsequently develop BSI are at risk for adverse outcomes. Research from high-income settings contrasts the dearth of information from transplant centers in low- and middle-income countries, such as South Africa. Therefore, this study from Johannesburg aimed to describe the clinical and demographic profile of children undergoing liver transplantation, and determine the incidence and pattern of BSI and associated risk factors for BSI during the first year after liver transplant. Pediatric liver transplants performed from 2005 to 2014 were reviewed. Descriptive analyses summarized donor, recipient, and post-transplant infection characteristics. Association between BSI and sex, cause of liver failure, age, nutritional status, PELD/MELD score, graft type, biliary complications, and acute rejection was determined by Fisher's exact test; and association with length of stay by Cox proportional hazards regression analysis. Survival estimates were determined by the Kaplan-Meier method. Sixty-five children received one transplant and four had repeat transplants, totaling 69 procedures. Twenty-nine BSI occurred in 19/69 (28%) procedures, mostly due to gram-negative organisms, namely Klebsiella species. Risk for BSI was independently associated with biliary atresia (44% BSI in BA compared to 17% in non-BA transplants; P = .014) and post-operative biliary complications (55% BSI in transplants with biliary complications compared to 15% in those without; P = .0013). One-year recipient and graft survival was 78% (CI 67%-86%) and 77% (CI 65%-85%), respectively. In Johannesburg, incident BSI, mostly from gram-negative bacteria, were associated with biliary atresia and post-operative biliary complications in children undergoing liver transplantation.
Collapse
Affiliation(s)
- Mary Duncan
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - AnneMarie DeVoll-Zabrocki
- College of Nursing, 985330 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Harriet R Etheredge
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather A Maher
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Carolyn Bouter
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Petra Gaylard
- Data Management and Statistical Analysis (DMSA), Johannesburg, South Africa
| | - Jerome Loveland
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Surgery, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean F Botha
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
|
17
|
Verma Y, Gupta E, Kumar N, Hasnain N, Bhadoria AS, Pamecha V, Khanna R. Earlier and higher rates of cytomegalovirus infection in pediatric liver transplant recipients as compared to adults: An observational study. J Lab Physicians 2020; 10:221-225. [PMID: 29692591 PMCID: PMC5896192 DOI: 10.4103/jlp.jlp_140_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM: To study and compare the incidence and time of occurrence of cytomegalovirus (CMV) infection in the posttransplant period in adult and pediatric liver transplant recipients. MATERIALS AND METHODS: Consecutive live donor liver transplant recipients not on CMV prophylaxis, were prospectively enrolled from March 2012 to September 2015 and followed up for 1 year post transplant to look for CMV infection. For analysis, patients were divided into pediatric (up to 18 years) and adult (>18 years) age groups. RESULTS: The study population of 146 patients consisted of 132 adult and 14 pediatric patients. Overall CMV infection posttransplant was seen in 54/146 (36.98%) patients, and 16/54 (29.6%) patients developed CMV disease. Post-transplant CMV infection rate was significantly higher in pediatric patients(10/14 [71.4%]) as compared to adults (44/132 [33.4%]) (P = 0.004). Among adults, CMV infection was seen in 22 (50%) patients in the 1st month, 13 (29.5%) patients in the 2nd month, 5 (11.4%) patients in the 3rd month, 2 (4.5%) patients in the 4th month, and 1 (2.3%) patient each in the 5th and 6th month. However, in pediatric patients, all the patients having CMV infection had it in the 1st-month posttransplant (P = 0.003). The median time of occurrence of CMV infection was 11.5 (7.75–19.00) days in pediatric patients versus 30 (18.5–54.5) days in adult patients (P = 0.001). CONCLUSIONS: The results of this study show a clear difference in the incidence and timeline of posttransplant CMV infection in pediatric patients as compared to adults.
Collapse
Affiliation(s)
- Yogita Verma
- Department of Clinical virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Clinical virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Niteen Kumar
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nadeem Hasnain
- Department of Clinical virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ajeet Singh Bhadoria
- Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| |
Collapse
|
|
18
|
Marie E, Navallas M, Navarro OM, Punnett A, Shammas A, Gupta A, Chami R, Shroff MM, Vali R. Posttransplant Lymphoproliferative Disorder in Children: A 360-degree Perspective. Radiographics 2019; 40:241-265. [PMID: 31834850 DOI: 10.1148/rg.2020190103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
An earlier incorrect version of this article appeared online. This article was corrected on December 17, 2019.
Collapse
Affiliation(s)
- Eman Marie
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - María Navallas
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Oscar M Navarro
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela Punnett
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amer Shammas
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aaryan Gupta
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rose Chami
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar M Shroff
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reza Vali
- From the Departments of Medical Imaging (E.M., M.N., O.M.N., A.S., M.M.S., R.V.), Pediatrics (A.P.), and Laboratory Medicine and Pathobiology (R.C.), University of Toronto, Toronto, Ontario, Canada; and the Department of Diagnostic Imaging (E.M., M.N., O.M.N., A.G., M.M.S.), Division of Pediatric Hematology/Oncology, Department of Pediatrics (A.P.), Division of Nuclear Medicine, Department of Diagnostic Imaging (A.S., R.V.), and Department of Pediatric Pathology and Laboratory Medicine (R.C.), The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
|
19
|
Riccardi N, Rotulo GA, Castagnola E. Definition of Opportunistic Infections in Immunocompromised Children on the Basis of Etiologies and Clinical Features: A Summary for Practical Purposes. Curr Pediatr Rev 2019; 15:197-206. [PMID: 31242834 PMCID: PMC7040525 DOI: 10.2174/1573396315666190617151745] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 02/08/2023]
Abstract
Opportunistic Infections (OIs) still remain a major cause of morbidity and death in children with either malignant or nonmalignant disease. OIs are defined as those infections occurring due to bacteria, fungi, viruses or commensal organisms that normally inhabit the human body and do not cause a disease in healthy people, but become pathogenic when the body's defense system is impaired. OIs can also be represented by unusually severe infections caused by common pathogens. An OI could present itself at the onset of a primary immunodeficiency syndrome as a life-threatening event. More often, OI is a therapyassociated complication in patients needing immunosuppressive treatment, among long-term hospitalised patients or in children who undergo bone marrow or solid organ transplantation. The aim of the present review is to provide a comprehensive and 'easy to read' text that briefly summarises the currently available knowledge about OIs in order to define when an infection should be considered as opportunistic in pediatrics as a result of an underlying congenital or acquired immune-deficit.
Collapse
Affiliation(s)
- Niccolò Riccardi
- Infectious Diseases Clinic, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.,Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Gioacchino Andrea Rotulo
- Infectious Diseases Department, Istituto Giannina Gaslini Children's Hospital, University of Genoa, Geno, Italy
| | - Elio Castagnola
- Infectious Diseases Department, Istituto Giannina Gaslini, Children's Hospital, Genoa, Italy
| |
Collapse
|
|
20
|
Pouladfar G, Jafarpour Z, Malek Hosseini SA, Firoozifar M, Rasekh R, Khosravifard L. Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran. Transpl Infect Dis 2018; 21:e13001. [DOI: 10.1111/tid.13001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/03/2018] [Accepted: 09/02/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Gholamreza Pouladfar
- Alborzi Clinical Microbiology Research Center, Nemazee Teaching Hospital; Shiraz University of Medical Sciences; Shiraz Iran
| | - Zahra Jafarpour
- Alborzi Clinical Microbiology Research Center, Nemazee Teaching Hospital; Shiraz University of Medical Sciences; Shiraz Iran
| | | | | | - Razieh Rasekh
- Shiraz Organ Transplant Center; Abu-Ali Sina Hospital; Shiraz Iran
| | | |
Collapse
|
|
21
|
Abstract
Solid-organ transplantation in pediatrics can be a life-saving procedure, but it cannot be accomplished without risk of infection-related morbidity and mortality. Evaluation of the recipient during candidacy and donor during evaluation can assist with identification of risk. Further, risk of infection from the surgical procedure can be mitigated through careful planning and attention to infection prevention processes. Finally, early recognition of infection posttransplant can limit the impact of these events.
Collapse
Affiliation(s)
- Elizabeth Doby Knackstedt
- Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah; Division of Transplant/Immunocompromised Infectious Diseases, Primary Children's Hospital, Salt Lake City, Utah
| | - Lara Danziger-Isakov
- Division of Pediatric Infectious Diseases, University of Cincinnati, Immunocompromised Host Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| |
Collapse
|
|
22
|
de St Maurice A, Halasa N. Ensuring adequate immunizations among pediatric liver transplant recipients: A team approach. Pediatr Transplant 2016; 20:1018-1019. [PMID: 27882686 DOI: 10.1111/petr.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| |
Collapse
|
|
23
|
Tsai KC, Danziger-Isakov LA, Banach DB. Cytomegalovirus Infection in Pediatric Solid Organ Transplant Recipients: a Focus on Prevention. Curr Infect Dis Rep 2016; 18:5. [DOI: 10.1007/s11908-015-0511-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
|
24
|
Fernandes A, Rocha L, Costa T, Matos P, Faria MS, Marques L, Mota C, Henriques AC. Infections Following Kidney Transplant in Children: A Single-Center Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojneph.2014.43017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|