title: Hospitalizations for Respiratory Syncytial Virus and Vaccine-Preventable Infections in the First 2 Years After Pediatric Liver Transplant.
abstract: To examine in liver transplant recipients at centers participating in the Pediatric Health Information System dataset the number of hospitalizations for respiratory syncytial virus (RSV) and vaccine-preventable infections (VPIs) in the first 2 years after transplantation, morbidity and mortality associated with these hospitalizations, and costs associated with these hospitalizations.
  
  
  
  A retrospective cohort study of patients <18 years of age who underwent liver transplantation at a Pediatric Health Information System center between January 1, 2004, and December 31, 2012. Hospitalizations for RSV/VPIs during the first 2 years post-transplant were ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Data were collected on clinical care, outcomes, and costs during these hospitalizations.
  
  
  
  There were 2554 liver transplant recipients identified; 415 patients (16.3%) had 544 cases of RSV/VPIs. RSV, rotavirus, and influenza were the most common infections resulting in hospitalization. Ninety-two patients (3.6%) had RSV/VPI during their transplant hospitalization. Transplant hospitalizations complicated by RSV/VPI were longer (44 days vs. 21 days; P < .001), had higher rejection rates (37% vs. 26%; P = .02), and were more expensive ($259 697 vs. $190 860; P < .001). Multivariate analyses identified age <2 years at transplant (P < .001) and multivisceral recipient (P = .04) as predictors of a hospitalization for RSV.
  
  
  
  VPIs occurred in 1 of 6 liver transplant recipients in the first 2 years post-transplant, a significantly higher rate than in the general pediatric population. These hospitalizations had substantial morbidity, mortality, and costs, demonstrating the importance of vaccinating patients before transplantation.
authors.affiliation: Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO; Pediatric Liver Transplant Program, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus & Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO. Electronic address: amy.feldman@childrenscolorado.org.
authors.forename: Amy G
authors.initials: AG
authors.lastname: Feldman
authors.affiliation: Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO; Pediatric Liver Transplant Program, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Shikha S
authors.initials: SS
authors.lastname: Sundaram
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus & Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus & Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014181:Transplantation Immunology; D014612:Vaccines / Q000008:administration & dosage
chemical_list: D014612:Vaccines
keywords: RSV; immunizations; influenza; vaccinations