Introduction Bacterial infections and bacteremia are an important cause of morbidity and mortality in the solid-organ transplant recipient during the first 2 months after sur- gery. The incidence of infection occurring during the immediate period following a liver transplantation (LTx) ranges from 25% to 85%, with an associated mortality rate of 10%–25% [3, 5, 8, 9, 11, 12, 13, 18, 19, 22, 23]. During this period, the incidence of bacteremia is approximately 30% [13, 20, 22, 23]. For the first 2 months after solid-organ transplanta- tion, risk factors associated with infections have been well described, including: male recipients, encephalopa- thy, thrombocytopenia, prolonged prothrombin time, hyperbilirubinemia, prolonged intensive care unit (ICU) stay, ventilatory support, urgency of LTx, chronic lung disease, prior colonization or latent infection, prolonged antibiotic therapy before LTx, diabetes mellitus, renal failure, use of central venous catheter (CVC), prolonged operating time, massive transfusions, allograft failure, infected donor organ, acute-rejection treatments and immunosuppression, intra-abdominal bleeding, re-op- eration, and vascular or biliary complications [5, 8, 15, 18, 19, 21, 22, 24]. Infections 2–6 months after solid-organ transplanta- tion are usually due to opportunistic micro-organisms or viral infections such as herpes viruses, adenovirus, and hepatitis B and C [3, 7, 17, 24]. By 6 months after solid- organ transplantation, the risk of bacterial infection for the uncomplicated adult patient has been reported to be at the level of the general population [6, 7, 11, 24]. Since most of these studies are on adults or mixed-age groups with an adult predominance, the long-term incidence of bacteremia in the uncomplicated child after solid-organ transplantation has not been defined well [3, 5, 8, 11, 12, 13, 22, 23]. In addition, children in the general popula- tion who are younger than 3 years of age are at an in- creased risk of incurring bacterial infections [1, 2, 10], adding to the concern that the post-transplant child is particularly at risk of developing bacteremia. The aim of this study was therefore to investigate the clinical ORIGINAL ARTICLE Transpl Int (2002) 15: 502–507 DOI 10.1007/s00147-002-0466-1 Rube´n E. Quiro´ s-Tejeira Marvin E. Ament Sue V. McDiarmid Mary Gonzalez Roberto Chong Jorge H. Vargas Martı´n G. Martı´n Late-onset bacteremia in uncomplicated pediatric liver-transplant recipients after a febrile episode Received: 11 June 2001 Revised: 24 April 2002 Accepted: 4 July 2002 Published online: 19 September 2002 Ó Springer-Verlag 2002 R.E. Quiro´s-Tejeira Æ M.E. Ament S.V. McDiarmid Æ M. Gonzalez R. Chong Æ J.H. Vargas Æ M.G. Martı´n (&) Department of Pediatrics, Division of Gastroenterology and Nutrition, UCLA Medical Center, 10833 Le Conte Avenue, 12-383 MDCC, Los Angeles, CA 90095-1752, USA E-mail: mmartin@mednet.ucla.edu Tel.: +1-310-7945532 Fax: +1-310-2060203 Abstract The aim of this study was to analyze the incidence and risk factors of bacteremia after a febrile episode in uncomplicated pediatric recipients more than 2 months after liver transplantation, which has not previously been studied. This cross- sectional study was conducted over a 4-year period. Patients with known risk factors for sepsis at the time of admission were excluded from the study. Seventy-one patients were hospitalized on 128 occasions, with bacteremia occurring in the case of 11 admissions (8.6%). No laboratory tests were predictive of bacteremia. The bacteremic group most fre- quently presented with ill appearance (P<0.001), lethargy (P<0.01), decreased physical activity, and a history of early-onset bacteremia after transplantation and segmental graft (P<0.05). This study identified a significant incidence of bacteremia in uncomplicated patients many months after liver transplantation. Keywords Biliary strictures Æ Immunosuppression Æ Segmental graft