Abstract

Living donor liver transplantation (LDLT), which was first demonstrated in 1989, has now been widely used to cure many late-stage hepatic diseases and has achieved huge success, especially in the pediatric field. However, accumulated studies indicate that early-stage infection after LDLT is the main cause leading to its failure and the death of the patient. Here, we retrospectively analyzed 25 cases (from 2006 to 2009) of infections of children in our hospital, underwent LDLT and their correlated factors. To identify the factors most closely related to early stage infection, we categorized early stage infection levels as either mild, moderate or severe and we compared their related risk factors, including total length of stay in hospital (TLSH), length of stay in the intensive care unit (LSI), duration of catheterization (DC), length of pre-/post-operative antimicrobial agent application, length of immuno-suppressant agent application (LISA) and underlying diseases postoperatively. The results revealed the following. (i) Of 25 patients, 24 recipients were infected to various extents: 6 cases of mild infection, 14 cases of moderate infection and 4 cases of severe infection (one patient died). (ii) TLSH, LSI and durations of preoperative (DPAA) and postoperative (DPOAA) antimicrobial agent application were statistically different between the severe and moderate infection groups (P = 0.03 (TLSH), 0.004 (LSI), 0.003 (LAPP), 0.005 (DPOAA). (iii) Between the severe and mild infection groups, the TLSH (P = 0.016), LSI (P = 0.015), DAPP (P = 0.007) and DPOAA (P = 0.001) were also significantly different. (iv) In the case of LISA, only methylprednisolone (P = 0.01) and the calcineurin inhibitor ciclosporin A (P = 0.009) showed statistically significant differences between the moderate and mild infection groups. (v) Biliary atresia is the predominant underlying liver disease. (vi) In contrast to previous findings, there was no significant difference in DC among the three infection groups. (vii) Of all the 25 patients, 24 survive till now and the only one died was diagnosed as portal vein thrombosis (PVT) combined with high white blood count (>30 x 10⁹/l) in venous blood. DPAA, DPOAA and biliary atresia are the risk factors most closely related to infection during liver transplantation in children, an observation worthy of future investigation. To avoid long term DPAA and long term DPOAA induced early severe infection, nosocomial infection control and drug resistant bacteria monitoring are worthy to be concerned after LDLT in children.

Key words: Living donor liver transplantation, risk factor, children.