Prevalence and risk factors of de novo atopic diseases in pediatric liver transplant recipients: A retrospective cohort study

Abstract

Background: Atopic diseases are common in pediatric liver transplant (LT) recipients, yet their prevalence, remission, and risk factors remain unclear. Objective: To investigate the prevalence, onset, remission, and risk factors for food allergy (FA), allergic rhinitis (AR), and asthma in pediatric LT recipients. Results: Among 118 pediatric LT recipients, 71 (60.2%) developed atopic diseases post-transplant. De novo FA was the most common (40.7%), with a median onset of 9.5 months after LT. Most cases were IgE-mediated, with cow's milk and egg as the most common allergens. Over 3 years, 56.3% outgrew at least one allergic food. AR was diagnosed in 24.4%, with house dust mites as the primary sensitizing allergens. Asthma was less frequent (3.4%). Younger age at LT (<2 years) significantly increased FA risk (OR: 5.5, 95% CI: 2.0–15.2), as did Epstein-Barr virus (EBV) reactivation (OR: 6.5, 95% CI: 1.2–33.8). AR risk was higher in those with a first-degree family history of atopy (OR: 5.6, 95% CI: 2.1–14.7) or an atopic organ donor (OR: 4.6, 95% CI: 1.3–16.2). Conclusion: De novo FA and AR are common in pediatric LT recipients, with significant associations with age at transplant, EBV reactivation, and genetic predisposition. Early monitoring and intervention are crucial to managing atopic diseases in this population.