437 - Invasive Fungal Disease in Pediatric Heart Transplant Recipients: A Single Center Study

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 437
Publication Number: 437.419

Matthew E. Naumann, UT Southwestern Medical Center - - Dallas, TX, Dallas, TX, United States; Samuel Davila, University of Texas Southwestern, Coppell, TX, United States

Presenting Author(s)

Matthew E. Naumann, MD

Pediatric Critical Care Fellow
UT Southwestern Medical Center - - Dallas, TX
Dallas, Texas, United States

Background: In 2019, 507 children underwent heart transplantation in the United States, with more than 6,000 total pediatric heart transplants performed since the practice began. Necessary to transplantation is immunosuppression which can be complicated by peri-transplant infections. The rate of bacterial infection in pediatric heart transplantation is high, with one study estimating 25%, but relatively little is known about fungal infections post-heart transplant, with one study estimating a fungal infection rate of 6.8%. At this time, it is not standard practice for patients to receive post-operative antifungal prophylaxis, and such therapy is generally not begun until after an invasive fungal infection is suspected.

Objective:

The objective of this study is to define the rates of invasive fungal infection following pediatric heart transplantation and identify associated risk factors.

Design/Methods:

This is a single center (Children’s Medical Center, Dallas, TX) retrospective chart review of all pediatric heart transplants from 2017-2020. Using simple univariate and multiple regression analysis, we identified risk factors associated with invasive fungal infection.

Results:

Of the 77 patients identified that met the inclusion criteria, 10 (13%) of the patients met the criteria for post-operative invasive fungal infection. A simple univariate analysis revealed the following associated risk factors: pre- and/or post-op renal replacement therapy, pre-op invasive mechanical ventilation, post-op ECMO, post-op antibacterials, and post-op bacterial infection. Multivariate regression analysis did not identify any independent risk factors. Patients with invasive fungal infection were also less likely to survive to hospital discharge (93% vs 60%, p=0.014) and had a significantly longer hospital length of stay (2.2 vs 3.1 months, p=0.033).

Conclusion(s):

We identified a post-heart transplant invasive fungal infection rate of 13% and multiple risk factors for infection. Children with invasive fungal infection had a longer hospital length of stay and were less likely to survive to hospital discharge. Further study is required to determine if prophylactic antifungal therapy would be beneficial to this patient population.