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


Theoklis E. Zaoutis, MD, MSCE, The Children’s Hospital of Philadelphia, CHOP North, 3535 Market Street, Room 1527, Philadelphia, PA 19104, USA
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Zaoutis TE, Webber S, Naftel DC, Chrisant MA, Kaufman B, Pearce FB, Spicer R, Dipchand AI on behalf of the Pediatric Heart Transplant Study Investigators. Invasive fungal infections in pediatric heart transplant recipients: Incidence, risk factors, and outcomes.
Pediatr Transplantation 2011: 15: 465–469. © 2010 John Wiley & Sons A/S.

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.