BACKGROUND: Viral upper respiratory infection (vURI) is common in children and its effect at the time of liver transplant (LT) on the post-operative outcomes is unknown. Unlike vURI screening by rapid antigen tests, PCR and culture results are often delayed until after LT.

OBJECTIVES: The purpose of this study is to describe the impact of vURI at the time of LT on post-transplant outcomes in children.

METHODS: All patients transplanted at a large pediatric institution from February 2009 to June 2015 received routine screening for vURI by rapid antigen test, PCR or viral culture on admission for LT. Patient records were reviewed for positive tests during the peri-transplant period, defined as within 24 hours prior to and 72 hours after LT.

RESULTS: 13 of 225 (5.8%) transplanted patients had viruses identified, including RSV (4), picornavirus (4), parainfluenza (3), adenovirus (1) and influenza A (1). Of these, only 1 vURI was detected by rapid testing prior to LT. 11 of 13 (85%) patients were symptomatic with cough (4), rhinorrhea (2), congestion (5) and wheezing (2), but all were afebrile with a normal chest x-ray at time of LT. 8 of 13 (62%) patients were 2 years of age or younger. 6 (46%) patients were in the intensive care unit (ICU) at time of organ allocation and 11 (85%) had acute liver failure or severe liver disease (status 1A, 1B, or PELD > 30). 10 (77%) patients required mechanical ventilation after surgery with median length of intubation of 15 (2-54) days. 3 patients required high frequency oscillatory ventilation. Median post-transplant length of stay was 27 days for patients with URI as compared to 9 days in patients with no URI matched for PELD, age and month of transplant (P<0.05). Incidence of graft failure due to hepatic artery thrombosis was increased in the positive vURI cohort (3 patients, 23%) as compared to all other patients transplanted during the study period (10 patients, 5%), P<0.05.

CONCLUSION: Viral URIs are not uncommon in liver transplant recipients and may contribute to morbidity, increased length of stay and graft failure after transplantation. The majority of patients who screened positive for vURI were symptomatic and had acute liver failure or severe liver disease. Clinical judgment must weigh the risks and benefits of liver transplantation in pediatric patients with vURI at the time of transplantation.

CITATION INFORMATION: Kohler J, Miloh T, Hosek K, Goss J, Munoz F. Impact of Peri-Transplant Viral Upper Respiratory Infection on Pediatric Liver Transplant Outcomes. Am J Transplant. 2017;17 (suppl 3).

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