title: Risk Factors for Bloodstream Infection After Living-donor Liver Transplantation in Children.
abstract: BACKGROUND
  Postoperative bloodstream infection (BSI) is the most important determinant of recipient morbidity and mortality after liver transplantation (LT). Children who underwent LT are at the highest risk of developing BSI because of the significant surgical intervention, use of multiple devices, and administration of immunosuppressive agents. However, information regarding the risk factors for BSI in children after LT is limited.
  
  
  METHODS
  We retrospectively reviewed 210 children who underwent living-donor LT at the largest pediatric LT center in Japan. Patients' characteristics, blood culture results and clinical outcomes were extracted from electronic medical records. Univariate and multivariate analyses were performed to identify the risk factors for BSI.
  
  
  RESULTS
  Among the 210 LT recipients, 53 (25%) recipients experienced 86 episodes of BSI during the observational period. The source of the BSI was identified only in 38%: catheter-related BSI (27%) peritonitis (7%), urinary tract infection (2%), pneumonia (1%) and infectious endocarditis (1%). A multivariate analysis demonstrated that body weight (P = 0.03), volume of blood loss during LT (P < 0.001) and cytomegalovirus (CMV) antigenemia positivity (P = 0.04) were independently associated with the development of BSI. The risk factors for BSI differed when we analyzed the subjects according to age (≤24 months and >24 months), blood loss and pediatric end-stage liver disease/model for end-stage liver disease versus positive CMV antigenemia.
  
  
  CONCLUSIONS
  The volume of blood loss, postoperative CMV antigenemia positivity and body weight were associated with the development of BSI after LT in pediatric living-donor recipients. To identify the age-specific predictors of BSI in children who underwent LT, age-specific analyses are crucial.
authors.affiliation: From the *Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; †Transplantation Center, National Center for Child Health and Development, Tokyo, Japan; ‡Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla; §Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and ‖Division of Infectious Diseases, Department of Pediatrics, University of California, San Diego, La Jolla.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Shoji
authors.forename: Takanori
authors.initials: T
authors.lastname: Funaki
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.forename: Florin
authors.initials: F
authors.lastname: Vaida
authors.forename: Kenta
authors.initials: K
authors.lastname: Ito
authors.forename: Isao
authors.initials: I
authors.lastname: Miyairi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saitoh
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors