Invasive fungal infections in pediatric heart transplant recipients: Incidence, risk factors, and outcomes

Theoklis E. Zaoutis, Steven Webber, David C. Naftel, Mary Anne Chrisant, Beth Kaufman, F. B. Pearce, Robert Spicer, Anne I. Dipchand

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

There are limited data on the incidence or risk factors for IFI in pediatric heart transplant recipients. The purpose of this study was to describe the incidence and types of IFI, to determine risk factors for outcomes of IFI, and to assist in decision-making concerning the need for prophylactic strategies in pediatric heart transplant recipients. Data from a multi-institutional registry of 1854 patients transplanted between 01/93 and 12/04 were analyzed to determine risk factors and outcomes of children with IFI post-heart transplantation. One hundred and thirty-nine episodes of IFI occurred in 123 patients and made up 6.8% of the total number of post-transplant infections. IFI was most commonly attributed to yeast (66.2%), followed by mold (15.8%) and Pneumocystis jiroveci (13%). Ninety percent of the yeast infections were caused by Candida spp., and Aspergillus spp. was causative in 82% of the mold infections. There was a significantly increased risk of fungal infection associated with pretransplant invasive procedures (e.g., ECMO, prior surgery, VAD, mechanical ventilation) with an incremental risk with increasing numbers of invasive procedures (early phase 0 vs. 1, RR 1.3; 0 vs. 3, RR 2.3; p < 0.001). In multivariate analysis, previous surgery (p = 0.05) and mechanical support at transplantation (p = 0.01) remained significant. Forty-nine percent of recipients with IFI died, all within six months post-transplant. Invasive fungal infections are uncommon in pediatric heart transplant recipients. Risk and mortality are highest in the first six months post-transplant especially in patients with previous surgery and those requiring mechanical support. Prophylactic strategies for high-risk patients should be considered and warrants further study.

Original languageEnglish (US)
Pages (from-to)465-469
Number of pages5
JournalPediatric Transplantation
Volume15
Issue number5
DOIs
StatePublished - Aug 1 2011

Fingerprint

Pediatrics
Incidence
Transplants
Fungi
Yeasts
Infection
Pneumocystis carinii
Mycoses
Aspergillus
Heart Transplantation
Candida
Artificial Respiration
Registries
Decision Making
Multivariate Analysis
Transplantation
Mortality
Transplant Recipients
Invasive Fungal Infections

Keywords

  • aspergillosis
  • candidiasis
  • fungal
  • heart transplantation
  • infection
  • pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Zaoutis, T. E., Webber, S., Naftel, D. C., Chrisant, M. A., Kaufman, B., Pearce, F. B., ... Dipchand, A. I. (2011). Invasive fungal infections in pediatric heart transplant recipients: Incidence, risk factors, and outcomes. Pediatric Transplantation, 15(5), 465-469. https://doi.org/10.1111/j.1399-3046.2010.01415.x

Invasive fungal infections in pediatric heart transplant recipients : Incidence, risk factors, and outcomes. / Zaoutis, Theoklis E.; Webber, Steven; Naftel, David C.; Chrisant, Mary Anne; Kaufman, Beth; Pearce, F. B.; Spicer, Robert; Dipchand, Anne I.

In: Pediatric Transplantation, Vol. 15, No. 5, 01.08.2011, p. 465-469.

Research output: Contribution to journalArticle

Zaoutis, TE, Webber, S, Naftel, DC, Chrisant, MA, Kaufman, B, Pearce, FB, Spicer, R & Dipchand, AI 2011, 'Invasive fungal infections in pediatric heart transplant recipients: Incidence, risk factors, and outcomes', Pediatric Transplantation, vol. 15, no. 5, pp. 465-469. https://doi.org/10.1111/j.1399-3046.2010.01415.x
Zaoutis, Theoklis E. ; Webber, Steven ; Naftel, David C. ; Chrisant, Mary Anne ; Kaufman, Beth ; Pearce, F. B. ; Spicer, Robert ; Dipchand, Anne I. / Invasive fungal infections in pediatric heart transplant recipients : Incidence, risk factors, and outcomes. In: Pediatric Transplantation. 2011 ; Vol. 15, No. 5. pp. 465-469.
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abstract = "There are limited data on the incidence or risk factors for IFI in pediatric heart transplant recipients. The purpose of this study was to describe the incidence and types of IFI, to determine risk factors for outcomes of IFI, and to assist in decision-making concerning the need for prophylactic strategies in pediatric heart transplant recipients. Data from a multi-institutional registry of 1854 patients transplanted between 01/93 and 12/04 were analyzed to determine risk factors and outcomes of children with IFI post-heart transplantation. One hundred and thirty-nine episodes of IFI occurred in 123 patients and made up 6.8{\%} of the total number of post-transplant infections. IFI was most commonly attributed to yeast (66.2{\%}), followed by mold (15.8{\%}) and Pneumocystis jiroveci (13{\%}). Ninety percent of the yeast infections were caused by Candida spp., and Aspergillus spp. was causative in 82{\%} of the mold infections. There was a significantly increased risk of fungal infection associated with pretransplant invasive procedures (e.g., ECMO, prior surgery, VAD, mechanical ventilation) with an incremental risk with increasing numbers of invasive procedures (early phase 0 vs. 1, RR 1.3; 0 vs. 3, RR 2.3; p < 0.001). In multivariate analysis, previous surgery (p = 0.05) and mechanical support at transplantation (p = 0.01) remained significant. Forty-nine percent of recipients with IFI died, all within six months post-transplant. Invasive fungal infections are uncommon in pediatric heart transplant recipients. Risk and mortality are highest in the first six months post-transplant especially in patients with previous surgery and those requiring mechanical support. Prophylactic strategies for high-risk patients should be considered and warrants further study.",
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