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A3687 - Modifiable Risk Factors for Infection in Pediatric Lung Transplant Recipients
Author Block: C. Onyearugbulem1, L. Williams2, Z. Huirong3, M. C. Gazzaneo4, E. Melicoff5, S. Das6, J. A. Coss-Bu6, F. Lam1, G. B. Mallory7, F. M. Munoz8; 1Pediatric Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States, 2Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States, 3Outcome and Impact Service, Texas Children's Hospital, Houston, TX, United States, 4Pediatric Critical Care, Baylor College of Medicine, Pearland, TX, United States, 5Pulmonary Medicine and Lung Transplant, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States, 6Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States, 7Pediatric Pulmonary, Texas Childrens Hosp, Houston, TX, United States, 8Infectious Diseases and Transplant Infectious Diseases, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Rationale: Although infection is the leading cause of death in the first year following pediatric lung transplantation, there are limited data on modifiable risk factors for infection. Sepsis remains under-recognized and under-reported in the early post-operative period for lung transplant recipients (LTR). We evaluated the incidence of infection and sepsis and identified risk factors for infection in the early post-operative period in pediatric LTRs.
Methods: A retrospective review of medical records of LTRs at a large quaternary-care hospital from January 2009 to March 2016 was conducted. Microbiology results on days 0 to 7 after transplant were obtained. Sepsis was defined using the 2005 International Pediatric Consensus Conference criteria. Potentially modifiable risk factors included history of recipient and donor infection, history of multi-drug resistant (MDR) infection, nutritional status, surgical times and duration of central venous access.
Results: Among 98 LTR there were 22 (22%) with post-operative infection. Prolonged donor ischemic time >7 h, cardiopulmonary bypass time > 340 mins, history of MDR infection and diagnosis of cystic fibrosis (CF) were significantly associated with infection. With multivariate regression analysis, only prolonged donor ischemic time remained significant (OR 4.58, 95% CI: 1.41 to 14.9). The incidence of sepsis was 24/98 (24.5%) among our pediatric LTR population. Within the CF sub-group, septic CF LTRs had significantly longer transplant duration of mechanical ventilation (p = 0.0074).
Conclusion: This is the first study to our knowledge that focuses on short-term morbidity, clinical outcomes and modifiable risk factors for infection during the first week after pediatric lung transplantation. Prolonged > 7 h donor ischemic time was significantly associated with infection after lung transplantation in our pediatric population. Sepsis was associated with increased immediate post-operative morbidity in the CF sub-group. Further research is needed to determine whether processes to reduce donor ischemic time could result in decreased post-transplant morbidity.