| To analyze the condition and risk factors of early (≤30days)pulmonary infection in children after living donor liver transplantation(LDLT).Methods: The clinical data of36cases who underwent LDLT inChildren’s Hospital of Chongqing Medical University between Jun2006andDecember2009were analyzed retrospectively in order to evaluate theincidence, outcome, high risk period, pathogenic characteristics and riskfactors of pulmonary infection. Univariate analysis was used to determinerelative risk factors leading to postoperative pneumonia, and significantfactors (P<0.05) were then used for multivariate logistic regression analysis．Results:(1) Of36cases without preoperative respiratory disease,17were boys,19were girls. Their age ranged from2months to14years.Pulmonary infection developed in24patients, of whom4cases died (17%)and3deaths were related to pulmonary infection.(2) Twenty cases (83%) ofpulmonary infection happened within first2weeks after LDLT.(3) Totally 65pathogenic strains were isolated, in which Gram-negative bacteria,Gram-positive bacteria and fungi were46strains,5strains,14strainsrespectively. The most frequently isolated bacteria were Pseudomonasaeruginosa (14strains), Klebsiella pneumoniae (8strains) and Acinetobacterbaumannii (8strains). Pseudomonas aeruginosa showed a resistance rate ofalmost100%to cotrimoxazole, tetracycline, chloramphenicol, ampicillin,the first, the second and some of the third generation cephalosporins.Klebsiella pneumoniae producing extended spectrum beta-lactamase had aresistance rate of almost100%to beta-lactams except carbapenems.Acinetobacter baumannii was exquisitely susceptible to carbapenems, butshowed the high resistance to penicillins and cephalosporins. Candidaalbicans, which was the most common fungus, showed a susceptibility rateof100%to amphotericin B. In the LDLT recipients of pulmonary infection,cytomegalovirus (CMV) infections occurred in2patients and Epstein Barrvirus (EBV) infection in1patient.(4) In univariate analysis, age≤1year,high Child-Pugh scores, hemoglobin <90g/L, congenital heart disease,mechanical ventilation>12hours, intraoperative transfusion>150ml/kg,indwelling gastric tube>3days and postoperative pleural effusion were ofstatistical significance (P<0.05). Multivariate logistic regression analysisshowed age≤1year, intraoperative transfusion>150ml/kg, indwelling gastrictube>3days and postoperative pleural effusion were independent risk factorsfor pneumonia after pediatric LDLT. Conclusions: Pulmonary infection was the most commonposttransplantation complication and the mortality should not be ignored.The high risk period for infection was within the first2weeks after operation.The pathogens were mainly Gram-negative bacteria, which showed high andmultidrug resistance. Age, intraoperative transfusion and indwelling gastrictube are independent risk factors for pulmonary infection. |
