Background: Surgical site infections (SSI) are a significant cause of morbidity among adult liver transplant (LT) recipients. Data on SSI epidemiology and SSI-associated outcomes among pediatric LT recipients is very limited. The goal of this study was to identify risk factors for SSI among pediatric LT recipients and evaluate outcomes associated with SSI in this patient population.

Methods: A single-center, retrospective descriptive analysis of patients age 18 years or less who underwent LT from September, 2007 through August, 2014 was performed. Risk factors and outcomes associated with SSI identified within the first 30 days post-operatively were identified using univariate analysis. Outcomes during the first 60 days post-transplant and patient and graft survival up to one year post-transplant were evaluated.

Results: Of 70 patients who underwent LT, 8 (11.4 %) developed subsequent SSI. SSI was more frequent among patients who underwent living donor transplantation (24.1 vs. 2.4%, p < 0.01) and associated with surgical, specifically biliary, complications (27.3 vs. 4.2%, p = 0.01 and 35.7 vs. 5.4%, p < 0.01 respectively). There were no post-transplant deaths and no graft losses associated with SSI. Those who developed SSI were more likely to undergo reoperation (62.5 vs. 17.8%, p = 0.01) and had more days of hospitalization in the first 60 days post-transplant (mean 36 vs. 19 days, p < 0.01).

Conclusions: SSI after pediatric LT is influenced by procedure-related factors and is associated with significant post-operative morbidity and likely cost as well. Pediatric patients with SSI risk factors, including those who undergo living donor transplantation and those with biliary complications, may benefit from intensified SSI preventive strategies.

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