Pediatric liver recipients display greater prevalence of RSV, influenza

SAN FRANCISCO — Vaccine-preventable diseases occur in 20% of pediatric liver transplant recipients, a rate nearly 66 times greater than that among the general pediatric population, according to data presented at The Liver Meeting 2015.

While influenza and respiratory syncytial virus represent common infections requiring pediatric hospitalizations, the impact of these infections remains unknown among pediatric liver transplant recipients.

To determine the number of hospitalizations for RSV, influenza, and other vaccine-preventable diseases among liver transplant recipients, Amy G. Feldman, MD, of Children’s Hospital Colorado, and colleagues retrospectively examined patients aged younger than 18 years (n = 2,554) who underwent liver transplantation from 2004 through 2013.

During this same time period, the researchers used ICD-9-CM diagnosis codes to identify subsequent hospitalizations for RSV, influenza, and 10 other vaccine-preventable diseases. Data were collected on clinical care, morbidity and mortality associated with these hospitalizations, as well as associated costs of hospitalizations.

According to the researchers’ data, 20% of pediatric liver transplant recipients reported cases of vaccine-preventable disease, with RSV (7.2%), influenza (6.6%), and rotavirus (5.8%) noted as the most common infections.

“Of 2,554 patients, 16% had a hospitalization for RSV or a vaccine preventable disease,” Feldman told Infectious Diseases in Children. “The case fatality rate was 5% for RSV and 2.5% for influenza. Transplant hospitalizations were significantly longer and more expensive when complicated by RSV or a vaccine preventable disease.”

In the first year after transplantation, 4% of all patients were hospitalized for RSV while 3.3% were hospitalized for influenza.

Excluding infections occurring during initial transplant hospitalization, the researchers found that rejection occurred in 15.9% of patients with RSV and 13.4% of patients with influenza, ventilation was required in 9.3% (RSV) and 5.9% (influenza), and ICU level care was reported in 20.9% (RSV) and 12.8% (influenza).

“This data highlights the importance of ensuring all patients and their families receive appropriate immunizations before and after transplant and raises the question of whether palivizumab might be useful for a select population of liver transplant candidates and recipients,” Feldman told Infectious Diseases in Children.

In addition, Feldman and colleagues determined the median inflation adjusted costs for hospitalization were $15,934 as a result of RSV and $7806 due to influenza. – by Bob Stott

Reference:
Feldman AG, et al. Abstract 137. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.