Infections and mortality following solid organ transplantation in children

Gwenn E McLaughlin, Shelley Wells, Sarah Newell, Charles L. Schleien

Research output: Contribution to journalArticle

Abstract

Introduction: Since June 1994, over 200 solid organ transplants have been performed at Jackson Children's Hospital. Through a retrospective chart review, we performed a three-year follow-up to identify both early and late infections in this patient population. Methods: Fifty-one patients undergoing solid organ transplantation from June 1994-December 1995 were identified from the PICU's patient database. Forty-one patient charts were available for review. Results: Forty-four transplants were performed (liver-21, kidney-12, heart-4, multivisceral-3, liver/islet cell-2, liver/small bowel-1, and liver/kidney-1. Immunosuppressive therapy consisted primarily of steroids and FK506. Kidney transplant patients also received OKT3 and azathioprine. All patients received Ganciclovir for viral prophylaxis. Most patients also received Cytomegalovirus (CMV) hyperimmuneglobulin. Nine bacterial infections, 2 fungal infections (Candida-1, Crytosporidia-1) and 11 viral infections (CMV-4, Respiratory Syncytial Virus-2, aseptic meningitis- 2, Epstein-Barr Virus related post-transplant lymphoproliferative disease (PTLD)-1, Rotavirus-1, Hepatitis C-1), and 1 pneumocystis infection were identified. Infections were more common in liver transplant recipients than kidney transplant recipients despite the presumably higher level of immunosuppression in the latter. Three-year survival was 85%. There was one early postoperative death and six late deaths. Late deaths all occurred within the first 6 months post-transplant due to Hepatitis C-1, CMV-2, PTLD-1, disruption of an arterial anastomosis secondary to Pseudomonas infection-1, and one death presumably due to sepsis. Thus, infection accounted for 100% of late deaths. Conclusions: Despite prophylaxis, CMV infection remains the most frequent viral infection after solid organ transplantation. The majority of deaths were attributable to viral infections.

Original languageEnglish
JournalCritical Care Medicine
Volume27
Issue number1 SUPPL.
StatePublished - Dec 1 1999

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Organ Transplantation
Mortality
Transplants
Infection
Virus Diseases
Cytomegalovirus
Liver
Kidney
Hepatitis C
Pneumocystis Infections
Aseptic Meningitis
Muromonab-CD3
Pseudomonas Infections
Ganciclovir
Respiratory Syncytial Viruses
Mycoses
Rotavirus
Azathioprine
Cytomegalovirus Infections
Tacrolimus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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Infections and mortality following solid organ transplantation in children. / McLaughlin, Gwenn E; Wells, Shelley; Newell, Sarah; Schleien, Charles L.

In: Critical Care Medicine, Vol. 27, No. 1 SUPPL., 01.12.1999.

Research output: Contribution to journalArticle

McLaughlin, Gwenn E ; Wells, Shelley ; Newell, Sarah ; Schleien, Charles L. / Infections and mortality following solid organ transplantation in children. In: Critical Care Medicine. 1999 ; Vol. 27, No. 1 SUPPL.
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abstract = "Introduction: Since June 1994, over 200 solid organ transplants have been performed at Jackson Children's Hospital. Through a retrospective chart review, we performed a three-year follow-up to identify both early and late infections in this patient population. Methods: Fifty-one patients undergoing solid organ transplantation from June 1994-December 1995 were identified from the PICU's patient database. Forty-one patient charts were available for review. Results: Forty-four transplants were performed (liver-21, kidney-12, heart-4, multivisceral-3, liver/islet cell-2, liver/small bowel-1, and liver/kidney-1. Immunosuppressive therapy consisted primarily of steroids and FK506. Kidney transplant patients also received OKT3 and azathioprine. All patients received Ganciclovir for viral prophylaxis. Most patients also received Cytomegalovirus (CMV) hyperimmuneglobulin. Nine bacterial infections, 2 fungal infections (Candida-1, Crytosporidia-1) and 11 viral infections (CMV-4, Respiratory Syncytial Virus-2, aseptic meningitis- 2, Epstein-Barr Virus related post-transplant lymphoproliferative disease (PTLD)-1, Rotavirus-1, Hepatitis C-1), and 1 pneumocystis infection were identified. Infections were more common in liver transplant recipients than kidney transplant recipients despite the presumably higher level of immunosuppression in the latter. Three-year survival was 85{\%}. There was one early postoperative death and six late deaths. Late deaths all occurred within the first 6 months post-transplant due to Hepatitis C-1, CMV-2, PTLD-1, disruption of an arterial anastomosis secondary to Pseudomonas infection-1, and one death presumably due to sepsis. Thus, infection accounted for 100{\%} of late deaths. Conclusions: Despite prophylaxis, CMV infection remains the most frequent viral infection after solid organ transplantation. The majority of deaths were attributable to viral infections.",
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