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Diaphragmatic dysfunction after pediatric orthotopic liver transplantation
Terezia I Manczur1, Anne Greenough, Gerrard F Rafferty
1Department of Child Health, King's College Hospital, London SE5 9RS, United Kingdom.
Transplantation
|February 1, 2002
Summary
Diaphragmatic dysfunction, not pleural effusion, is linked to longer breathing support and intensive care stays after pediatric liver transplants. Early assessment and management of diaphragmatic function may improve outcomes for these children.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Critical care medicine
Background:
- Pediatric orthotopic liver transplantation (OLT) generally has low mortality.
- Adverse outcomes include prolonged mechanical ventilation and intensive care unit (PICU) stays.
- Factors influencing these outcomes require further investigation.
Purpose of the Study:
- To identify pre-transplant factors and post-transplant complications associated with adverse outcomes in pediatric OLT.
- Specifically, to examine the role of pleural effusion and diaphragmatic dysfunction.
Main Methods:
- A cohort of 210 children undergoing OLT was analyzed.
- Patients were categorized into acute liver failure (ALF), chronic liver disease at home (CHOM), or chronic liver failure in hospital (CHOSP) groups.
- Data collected included duration of ventilatory support (intermittent positive pressure ventilation [IPPV]), PICU stay, and development of pleural effusion and diaphragmatic dysfunction.
Main Results:
- Children with ALF required significantly longer IPPV and PICU stays compared to other groups.
- Diaphragmatic dysfunction was significantly associated with prolonged ventilation and PICU stay (P<0.01 and P<0.05, respectively).
- Pleural effusion development did not show a significant association with prolonged ventilation or PICU stay.
Conclusions:
- Diaphragmatic dysfunction is a significant predictor of increased morbidity (prolonged ventilation and PICU stay) following pediatric OLT.
- Early assessment and proactive management of diaphragmatic function are recommended to potentially improve patient outcomes.