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Early critical care course in children after liver transplant

Vinay Kukreti1, Hani Daoud1, Sundeep S Bola2

  • 1Department of Pediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, P.O. Box 5010, London, ON, Canada N6A 5W9.

Critical Care Research and Practice
|October 21, 2014
PubMed

Insights

Pediatric liver transplant patients face complications, but recent outcomes show reduced infection and rejection rates. However, these children now require longer intensive care stays and mechanical ventilation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hepatology
  • Transplantation Surgery

Background:

  • Orthotopic liver transplantation (OLT) is a life-saving procedure for children with end-stage liver disease.
  • The postoperative course in pediatric intensive care units (PICUs) can be complex, with various potential complications.
  • Understanding trends in critical care management and outcomes is crucial for improving patient care.

Purpose of the Study:

  • To review the critical care course and outcomes of pediatric patients undergoing orthotopic liver transplantation (OLT).
  • To identify factors influencing length of stay (LOS) and mechanical ventilation (MV) duration.
  • To compare outcomes between different time periods to assess changes in care and patient profiles.

Main Methods:

  • Retrospective chart review of pediatric patients admitted to the PICU post-OLT.
  • Analysis of data from 145 patients (149 transplants) between 1988 and 2011.
  • Statistical analysis to identify predictors of LOS and MV, and to compare outcomes between early (1988-1999) and recent (2000-2011) groups.

Main Results:

  • Overall 28-day mortality was 8%; median LOS was 7 days; median MV was 3 days.
  • Predictors for LOS included open abdomen, patient age, and day 2 oxygenation index.
  • Predictors for MV duration included open abdomen, age, intraoperative blood transfusion, and PRISM III score.
  • Infection occurred in 28% and acute rejection in 24% of patients.
  • The recent group (2000-2011) featured younger recipients, reduced infection/rejection rates, but longer LOS and MV compared to the earlier group.

Conclusions:

  • Postoperative care for pediatric OLT patients involves significant complications.
  • Recent trends show OLT in younger children, with decreased infection and rejection rates.
  • Despite improvements, recent cohorts require extended mechanical ventilation and intensive care unit stays.

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