The Turkish Journal of Pediatrics 2023 , Vol 65 , Num 3
Early period intensive care follow-up after liver transplantation in children: a single center experience
Edin Botan 1 ,Emrah Gün 1 ,Setenay Akyüzlüer Güneş 8 ,Anar Gurbanov 1 ,Hasan Özen 1 ,Zarife Kuloglu 2 ,Ceyda Kırsaçlıoğlu 2 ,Elvan Onur Kırımker 4 ,Özlem Can Selvi 7 ,Ergin Çiftçi 3 ,Suat Fitöz 6 ,Meltem Koloğlu 5 ,Aydan Kansu 2 ,Deniz Balcı 4 ,Tanıl Kendirli 1
1 Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara
2 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University Faculty of Medicine, Ankara
3 Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara
4 Department of General Surgery and Liver Transplantation, Ankara University Faculty of Medicine, Ankara
5 Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara
6 Department of Radiology, Ankara University Faculty of Medicine, Ankara
7 Department of Anaesthesia and Intensive Care, Ankara University Faculty of Medicine, Ankara
8 Department of Pediatrics Ankara University Faculty of Medicine, Ankara, Türkiye
DOI : 10.24953/turkjped.2022.743 Background. Liver transplantation (LT) is a well-established, life-saving treatment for children with irreversible acute and chronic liver failure (LF). We aimed to evaluate the factors associated with morbidity and mortality in the early period of LT in children by reviewing our pediatric intensive care unit (PICU) experience.

Methods. We reviewed children`s medical records followed in the PICU after LT between May 2015-August 2021, including demographic parameters, indications for LT, operative variables, respiratory and circulatory support requirements, LT-related complications and survival.

Results. During this period, 40 pediatric patients who underwent LT were evaluated. LT was performed in 35 (87.5%) cases of chronic liver disease and 5 (12.5%) cases of acute liver failure. Twenty-four patients had chronic liver failure due to cholestatic liver disease. The patients` Pediatric Risk of Mortality (PRISM) III score was 18.82±SD (2-58) at PICU admission. 1-year survival was 87.5%, and overall survival was 85%. Younger age, low body weight, preoperative pediatric end-stage liver disease (PELD), and model for end-stage liver disease (MELD) values of 20 and higher were important risk factors for unfavorable outcomes after living donor liver transplantation (LDLT). These risk factors are both associated with technically more challenging vascular and bile duct reconstruction and higher complication rates, and increased mortality during the early period after LT.

Conclusions. The early period of optimum PICU management in pediatric LT recipients is crucial for successful outcomes, which is also related to the patients` characteristics, disease severity scores, and surgical procedures. Keywords : liver transplantation, pediatric intensive care, children

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