Hospitalizations for respiratory syncytial virus and vaccine preventable illnesses in the first two years following pediatric liver transplant

Abstract

Vaccine preventable infections are a recognized and potentially serious complication following solid organ transplant. Compared to healthy children, infections in organ transplant recipients are more likely to be complicated and even life threatening. However, the true incidence, morbidity, mortality, and costs resulting from hospitalizations for vaccine preventable illnesses in the pediatric liver transplant population remain unknown. The objectives of this study were to examine in liver transplant recipients at centers participating in the Pediatric Health Information System (PHIS) dataset: (1) number of hospitalizations for respiratory syncytial virus (RSV) and vaccine preventable illnesses (VPIs) in the first two years following transplant; (2) morbidity and mortality associated with these hospitalizations; and (3) costs associated with these hospitalizations. A retrospective cohort study of patients <18 years of age who underwent liver transplantation at a PHIS center between January 1, 2004, and December 31, 2012. Hospitalizations for RSV/VPIs during the first two years post-transplant were ascertained using ICD-9-CM diagnosis codes. Data were collected on clinical care, outcomes, and costs during these hospitalizations. 2,554 liver transplant recipients were identified; 415 (16.3%) of the patients had a total of 544 cases of RSV/VPIs. RSV, rotavirus and influenza were the most common infections resulting in hospitalization. Ninety-two patients (3.6%) had RSV/VPI during their transplant hospitalization. Transplant hospitalizations complicated by RSV/VPI were longer (44 days vs. 21 days, p<0.001), had higher rejection rates (37% vs. 26%, p=0.02), and were more expensive ($259,697 vs. $190,860, p<0.001). Multivariate analyses identified age < 2 at transplant (p<.001) and multivisceral recipient (p=0.04) as predictors of a hospitalization for RSV. In conclusion, VPIs occurred in 1 of 6 liver transplant recipients in the first two years post-transplant, a significantly higher rate than in the general pediatric population. These hospitalizations had substantial morbidity, mortality and costs demonstrating the importance of vaccinating patients prior to transplant.