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Pulmonary complications following liver transplantation in pediatric patients
C L Mack1, J M Millis, P F Whitington
1Department of Pediatrics, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
Insights
Most children experience pulmonary complications after liver transplants, but deaths from these issues are rare. Persistent pleural effusions may signal allograft rejection in pediatric liver transplant recipients.
Area of Science:
- Pediatric Medicine
- Transplantation Surgery
- Pulmonology
Background:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for children with end-stage liver disease.
- Pulmonary complications are a significant concern following pediatric OLT, impacting patient outcomes.
- Understanding the spectrum and incidence of these complications is crucial for improving post-transplant care.
Purpose of the Study:
- To define the incidence and types of pulmonary complications in children after OLT.
- To identify potential risk factors for persistent pleural effusions post-transplantation.
- To analyze the outcomes of various pulmonary complications in this pediatric population.
Main Methods:
- Retrospective review of radiological and medical records for pediatric OLT patients over a 3-year period.
- Identification of pulmonary abnormalities through radiological assessment.
- Detailed analysis of pulmonary disorder characteristics, including type, duration, therapy, and outcomes.
- Statistical analysis to determine risk factors for persistent pleural effusions.
Main Results:
- 151 OLTs were performed on 113 children; 27 developed pneumonia (bacterial, viral, fungal), with 3 deaths. Mild pulmonary hemorrhage and calcifications occurred in a few patients.
- 16 patients had right hemidiaphragm paralysis; 86 developed pleural effusions, with 38 persisting >7 days. Persistent effusions were linked to higher allograft rejection rates (p < 0.01).
- Seven patients required tracheostomy; outcomes varied, including decannulation, death from non-pulmonary causes, and ongoing ventilator support. Only one patient developed significant chronic lung disease.
Conclusions:
- The majority of children experience at least one pulmonary complication after OLT, but mortality directly from pulmonary disease is low.
- Persistent pleural effusions may serve as an early indicator of allograft rejection in pediatric liver transplant recipients.
- Bacterial, viral, and fungal pneumonias were the sole pulmonary causes of mortality in this cohort.
Abstract:
The purpose of this study was to define the incidence and type of pulmonary complications experienced by children after orthotopic liver transplantation (OLT). The radiological records of all patients receiving OLT during a 3-yr period were reviewed to identify evidence of a pulmonary abnormality. Medical records were then reviewed to determine type, duration, therapy and outcome of pulmonary disorders. Potential risk factors for the development of persistent pleural effusions were also analyzed. One hundred and fifty-one pediatric liver transplantations were performed on 113 patients during this period. Pneumonia developed in 27 patients, including 11 proven bacterial, six presumed bacterial, six viral and four fungal cases. All three deaths related to pulmonary complications were in this group. Three patients developed mild pulmonary hemorrhages, and three developed pulmonary calcifications, which did not impair lung function. Sixteen patients developed paralysis of the right hemidiaphragm, four required diaphragm plication. Pleural effusions developed in 86 patients, 38 persisted longer than 7 days. Patients with persistent effusions were more likely to develop allograft rejection than patients with no persistent effusion (p < 0.01) by chi2 analysis. Seven patients required tracheostomy placement. Of these, four were successfully decannulated, two died from non-pulmonary complications and one is receiving home ventilator support. In conclusion, the majority of children experience at least one pulmonary complication after OLT, but mortality due to pulmonary disease is low in this population. Persistent pleural effusions may be a heralding sign of allograft rejection. Viral, bacterial and fungal pneumonia were the only pulmonary causes of death and only one patient in this series has had significant chronic lung disease.