Association Between Mortality and Detection of Respiratory Viruses in Children During the Peri-Liver Transplant Period

Background: To evaluate the disease burden, risk of complications and mortality in children with viral detection during the peri-liver transplant period. Methods: A retrospective cohort study was conducted between January 2020 and December 2023 at a tertiary university hospital. Children who underwent multiplex polymerase chain reaction testing from 7 days before to 14 days after liver transplantation were included. The primary outcome was the association between peri-transplant viral detection and mortality. Data were obtained from the hospital’s medical records and laboratory databases. Results: A total of 169 children with a median age of 0.9 (interquartile range, 0.5–7.1) years were included. The primary indication for liver transplantation was biliary atresia with liver cirrhosis (47.3%). Living-donor transplantation was performed in 89.9% of cases. Viral detection occurred in 38.5% (65/169) of children, with 57% detected pre-transplant. The most frequently identified viruses were rhinovirus/enterovirus, adenovirus and parainfluenza. Children with viral detection had higher odds of mortality [20% vs. 8.7%; adjusted odds ratio (aOR), 2.56 (95% confidence interval [CI], 1.02–6.42); P = 0.03] and surgical complications [aOR, 2.18 (95% CI, 1.12–4.27); P = 0.02], regardless of the transplant indication or donor type. Bacterial coinfection further increased the odds of mortality in the viral detection group [aOR, 2.64 (95% CI, 1.06–6.61); P = 0.03]. Conclusions: In children with severe hepatocellular dysfunction undergoing liver transplantation, respiratory viral detection during the peri-transplant period was associated with an increased risk of mortality and postoperative surgical complications.