Infection after pediatric liver transplant

Kids are at a higher risk of infection after liver transplant surgery. This is because they’re taking immunosuppressant medications to keep their body from rejecting the new organ.

Some infections after transplant are common. Most of those are minor, but some can be fatal. 

Dr. Tess Barton, Pediatric Infectious Disease specialist at University Health, discusses ways to watch for infection and how to help your child after their transplant surgery.

Opportunistic Infections

Your child is most at risk of getting an infection in the first six months after surgery. 

“Opportunistic infections are infections with germs, with microbes, that would otherwise not cause infection and don't normally hurt us,” Dr. Barton said. But because your child is on medication that suppresses their immune system, their body doesn’t fend off the germs as well. 

Opportunistic infections could be caused by flora and fauna already living inside our bodies. These germs are normally dormant and fought off by our immune system. The medicines used to keep the immune system from attacking the transplant also keep it from controlling these microbes.

“Cytomegalovirus (CMV), herpes and Epstein-Barr Virus – those are the big three,” Dr. Barton said.

Risk Factors for Infection

Certain factors may put your child at a higher risk of infection post-transplant. These include:

  • Infections circulating in your community, like RSV or tuberculosis
  • If the donor had these infections before
  • Breathing in certain environmental fungi that live in the soil
  • Episodes of organ rejection, because extra immune suppressing medicines are given

Signs of Infection after Liver Transplant

After you bring your child home from the hospital, it’s important to stay vigilant for signs of infection. These could include: 

  • Fever 
  • Rashes
  • Diarrhea
  • Cough

How to Prevent Infection Pre- and Post-Transplant

Staying healthy before transplant is as important as staying healthy after. If your child gets an infection before a planned transplant, the surgery will likely be postponed, and you’ll have to wait for another organ.

Dr. Barton recommended these tips for avoiding infection: 

  • Get up to date on all vaccinations, including COVID-19 and flu
  • Avoid big family gatherings and birthdays in the month leading up to a planned transplant
  • Practice good handwashing
  • Wear a mask when appropriate
  • Don’t let your pets lick your face
  • Assign the litter box cleaning chores to someone else

Rejection after Transplant

After their transplant, your child will be required to attend follow-up visits with their transplant team. During these visits, your health care provider will draw your child’s blood and test it for signs of rejection. 

Your child’s body might “reject” the new organ as foreign and attack it. If this happens, your health care team will give your child more immunosuppressant medication to calm the immune system down. Because their immune system would be further weakened, your child may be more susceptible to infection during this time.

Is Risk for Infection Higher from a Living or Deceased Donor?

“The risk is often higher from a deceased donor, because we don’t always know their full infection history,” Dr. Barton said. 

Before your child undergoes their transplant, they are screened and tested for viruses and infections to ensure the surgery goes smoothly. Living donors go through a similar screening process. They’re tested for a number of viruses and infections, so if they carry a certain disease, it will be caught before the new organ is transplanted.

“With deceased donors, although you may get that testing at the time of transplant, you don't have that kind of pre-screening opportunity, necessarily, because that's a more sudden event,” Dr. Barton said.

Pediatric Liver Transplant at University Health

University Children’s Health is the only hospital in South Texas to offer living liver transplants for children. We also have one of the largest pediatric liver transplant programs in Texas and have performed more than 2,000 life-saving surgeries. 

Call 210-567-5777 for more information or request a consultation online.

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