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Intensive care for children after orthotopic liver transplantation
D Moulin1, S Clement de Clety, M Reynaert
1Department of Intensive Care, University of Louvain, Brussels, Belgium.
Insights
This study analyzes pediatric liver transplant outcomes, detailing surgical, immunosuppression, and graft-related complications. Key findings highlight significant patient morbidity and mortality following orthotopic liver transplantation (OLT) in children.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Immunosuppression Therapy
Background:
- Orthotopic liver transplantation (OLT) is a critical intervention for pediatric liver failure.
- Management of children undergoing OLT presents unique challenges and requires careful monitoring.
Purpose of the Study:
- To review the clinical experience and outcomes of pediatric patients undergoing OLT.
- To identify and analyze complications associated with OLT in children.
Main Methods:
- Retrospective analysis of 50 pediatric patients who underwent OLT between March 1984 and April 1987.
- Detailed review of surgical, immunosuppression-related, and graft-related complications.
Main Results:
- Hospital mortality was 14%. Common complications included abdominal infections, respiratory issues, and bacterial/fungal infections.
- Cyclosporin A (CsA) side effects were frequent, including hypertension and renal toxicity, exacerbated by co-administered nephrotoxic drugs.
- Graft dysfunction occurred due to primary non-function, hepatic artery thrombosis, rejection, and other hepatic pathologies.
Conclusions:
- Pediatric OLT management involves significant surgical and medical challenges.
- Close monitoring for complications, including infections and CsA toxicity, is crucial for improving outcomes.
- Early recognition of graft dysfunction is essential for timely re-transplantation.
Abstract:
We report our experience in the management of children after orthotopic liver transplantation (OLT). From 03/84 to 04/87 50 patients (pts) were transplanted. Mean age was 4 3/12 years (8/12 to 13 2/12) and mean body weight 14.7 kg (5.8 to 40). Hospital mortality was 14%. Problems related to the surgery included: Abdominal complications: bleeding (8 pts), infection (18 pts), ascites and fistula (1 pt), need for secondary abdominal surgery (10 patients). Respiratory problems: lobar atelectasis (11 pts), right diaphragmatic paralysis (2 pts) and right pleural effusion (11 pts). Problems related to immunosuppression included: Bacterial infection (29 pts) fungal infection (5 pts), one patient died of disseminated cytomegalovirus infection. Side effect of cyclosporin A (CsA) were systemic blood hypertension (S.B.H.) (47 pts), sinusal bradycardia (37 pts), associated to SBH (24 pts), hypertensive encephalopathy (2 pts). Generalized seizures (2 pts in the absence of SBH). Renal side effects of CsA were hypercreatininemia, decreased sodium bicarbonate and hyperkaliemia. The nephrotoxicity of CsA was favoured by the use of other nephrotoxic drugs such as aminoglycosides, amphotericin B. Edematous pancreatitis was observed in 3 patients and related to the use of large doses of steroids. Problems related to the functioning of the graft included: Primary non-function of the graft (4 pts), hepatic artery thrombosis (8 pts) and severe acute rejection unresponsive to therapy (1 pt); these situations needed to be recognised early in order to organize a second OLT. Other causes of hepatic dysfunction were: portal vein thrombosis (1 pt), biliary tract obstruction (2 pts), angiocholitis (3 pts), right hepatic lobe necrosis (2 pts). Acute hepatic insufficiency in 7 children.(ABSTRACT TRUNCATED AT 250 WORDS)