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Intensive care management after pediatric liver transplantation: a single-center experience
R Ganschow1, D Nolkemper, K Helmke
1Department of Pediatrics, University Hospital Hamburg Eppendorf, Germany. ganschow@uke.uni-hamburg.de
Insights
Improved intensive care management significantly reduced complications and mortality in pediatric liver transplantation (LTx). Enhanced monitoring and interventions led to shorter ICU stays and ventilation times, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Critical Care Medicine
Background:
- Liver transplantation (LTx) in children presents unique challenges in post-operative intensive care.
- Optimizing intensive care unit (ICU) management is crucial for improving outcomes in pediatric LTx recipients.
Purpose of the Study:
- To evaluate the impact of evolving intensive care management strategies on morbidity and mortality following pediatric liver transplantation.
- To assess improvements in ICU care over distinct time periods.
Main Methods:
- Retrospective analysis of 195 pediatric liver transplants performed between October 1991 and February 1998.
- Comparison of key outcomes including ICU stay, ventilation time, mortality, surgical complications, infections, and rejection episodes across three study periods.
- Implementation of intra-operative Doppler ultrasound to detect vascular complications.
Main Results:
- Significant reductions observed in ICU length of stay (9.7 to 4.7 days) and mechanical ventilation duration (5.2 to 1.2 days) over the study period (p < 0.001).
- Overall mortality was 18.0%, with a notable decrease in severe surgical complications.
- Intra-operative Doppler ultrasound identified 27 correctable vascular complications; acute cellular rejection occurred in 64.1% of patients.
Conclusions:
- Continuous improvement in intensive care management and monitoring is critical for reducing morbidity and mortality in pediatric liver transplantation.
- Shorter ICU stays and ventilation times correlate with enhanced care protocols.
- Effective management of complications, including vascular issues and infections, is essential for successful pediatric LTx outcomes.
Abstract:
A retrospective study was conducted to determine the significance of intensive care management on outcome after liver transplantation (LTx) in children. Of 195 transplants performed in 162 children, factors affecting morbidity and mortality were documented during the post-operative intensive care unit (ICU) stay. To assess the gain in experience of ICU management, we compared mean ventilation time and stay in the ICU as well as mortality, incidence of surgical complications, infections, and rejection episodes, during three different time-periods (October 1991-August 1994, September 1994-July 1996, and August 1996-February 1998). The time spent by patients in the ICU (9.7 days vs. 7.9 days vs. 4.7 days, p < 0.001) and time on ventilation (5.2 days vs. 3.1 days vs. 1.2 days, p < 0.001) were significantly reduced over the duration of the study. The overall mortality was 18.0% (n = 30) and 76.7% (n = 23) of these deaths occurred during the early post-operative period in the ICU. The incidence of severe surgical complications decreased significantly over time, and the application of intra-operative Doppler ultrasound since 1994 led to detection of 27 correctable vascular complications. The overall incidence of acute cellular rejection episodes in our center was 64.1%: 43.5% of the infectious episodes occurred in the ICU (bacterial 70.2%, viral 12.3%, and fungal 17.5%). The main side-effect from immunosuppressive drugs was arterial hypertension in 29% of the patients. We conclude that our efforts to improve intensive care management and monitoring were the key elements in reducing morbidity and mortality after pediatric LTx.