Published online Jan 27, 2021. doi: 10.4254/wjh.v13.i1.120
Peer-review started: June 25, 2020
First decision: October 21, 2020
Revised: November 12, 2020
Accepted: November 28, 2020
Article in press: November 28, 2020
Published online: January 27, 2021
Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children. Immunization strategies to prevent vaccine-preventable infections (VPIs) can effectively minimize this infection burden. However, data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited.
To evaluate the immunization status, VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant.
The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital (Bangkok, Thailand) were retrospectively reviewed. Immunization status was evaluated via their vaccination books. Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated, and divided into VPIs and non-VPIs. Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded. Severity of infection, length of hospital stay, ventilator support, intensive care unit requirement, and mortality were assessed.
Seventy-seven children with a mean age of 3.29 ± 4.17 years were included in the study, of whom 41 (53.2%) were female. The mean follow-up duration was 3.68 ± 1.45 years. Fortyeight children (62.3%) had vaccination records. There was a significant difference in the proportion of children with incomplete vaccination according to Thailand’s Expanded Program on Immunization (52.0%) and accelerated vaccine from Infectious Diseases Society of America (89.5%) (P < 0.001). Post-liver transplant, 47.9% of the children did not catch up with age-appropriate immunizations. There were 237 infections requiring hospitalization during the 5 years of follow-up. There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations. The risk of serious infection was high in the first year after receiving a liver transplant, and two children died. Respiratory and gastrointestinal systems were common sites of infection. The most common pathogens that caused VPIs were rotavirus, influenza virus, and varicella-zoster virus.
Incomplete immunization was common pre- and post-transplant, and nearly all children required hospitalization for non-VPIs or VPIs within 5 years post-transplant. Infection severity was high in the first year post-transplant.
Core Tip: Incomplete age-appropriate immunization in children waiting for a liver transplant was expected, and nearly half of them had not caught up with age-appropriate vaccinations post-transplant. Though there was no significant difference in hospitalization from vaccine-preventable infections (VPIs) and non-VPIs in children with complete and incomplete immunizations. At least 13.1% required hospitalization within 5 years post-transplant, and > 10% were admitted to the intensive care unit and required respiratory support. The severity of infections was high during the first year post-transplant. Complete immunization and robust infection control should be prioritized in children both pre and post-liver transplant.