*Purpose: Invasive fungal disease (IFD) among pediatric solid organ transplant recipients is a relatively rare event, however often results in death. There are many factors which occur during the post-transplant course that may predict IFD including the type of transplant and age of recipient. Liver and intestine play unique roles in immune surveillance for invasive pathogens. The intestinal tract is rich in immune cell populations which act as first responders to tissue damage and infection. Disturbance in the gut mucosal barrier or alteration in its immune function have been linked to invasive fungal infections. Viral infections such as CMV and EBV have been indicated to alter host immune function and may be risk factors which predispose patients to invasive fungal disease.

*Methods: A retrospective analysis of all pediatric patients (n=120) who underwent intestinal or liver transplant (2008 to 2018) was evaluated to compare Cytomegalovirus and Epstein Barr virus DNAemia as a risk factor for invasive fungal disease after transplantation. Other factors such as age, gender, type of transplant, and immunosuppression regimen were also analyzed as possible co-contributors. The study investigated by Kaplan Meier graphs the time until first invasive fungal infection comparing patients who experienced CMV or EBV DNAemia to those whom had not. Lastly, the study analyzed outcomes related to invasive fungal infection and antecedent viral infection such as mortality and graft failure.

*Results: There were 40 intestinal transplant and 80 liver transplant recipients who met inclusion criteria. Intestinal transplant and liver transplant recipients had similar rates of CMV and EBV DNAemia (CMV at 22-23%; EBV at 27-35%). Ages ranged from 6 months to 23 years old, (average of 7 Years old). Patients who experienced EBV viremia have an increased likelihood of IFD by 1.7 times (p=0.21). In addition, the presence of EBV viremia shortened the time to IFD from an average of 160 days to 60 days (p=0.014). CMV shows no impact on the rate of IFD (p=0.94). Concordant with previous data, intestinal transplant recipients are at significantly higher risk of developing fungal disease, 25% compared to 5% of liver recipients (p=0.001). Patients who develop an invasive fungal disease are 13 times more likely to die within a year post transplant.

*Conclusions: DNAemia with EBV during the post-transplant period appears to be a significant risk factor for the development of invasive fungal disease. Further study may elucidate mechanisms for EBV related immune disturbance explaining the observed correlation between EBV DNAemia and Invasive Fungal Disease.

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