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Effect of Graft Weight to Recipient Body Weight Ratio on Hemodynamic and Metabolic Parameters in Pediatric Liver
Zeynep Ersoy1, Serife Kaplan, Aycan Ozdemirkan
1Department of Anesthesiology, Baskent University, Ankara, Turkey.
Insights
A large graft weight-to-bodyweight ratio in pediatric liver transplant is linked to significant intraoperative hemodynamic and metabolic instability. This highlights the critical need for appropriate graft sizing in pediatric liver transplantation to improve patient outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Hepatology
Background:
- Graft size is a critical factor in organ transplantation success.
- The impact of graft weight-to-bodyweight ratio on pediatric liver transplant outcomes requires further investigation.
Purpose of the Study:
- To analyze the effect of graft weight-to-bodyweight ratio on intraoperative and early postoperative hemodynamic and metabolic parameters in pediatric liver transplant recipients.
Main Methods:
- Retrospective review of 130 pediatric liver transplant cases between 2005 and 2015.
- Patients categorized into two groups: large-for-size graft (>4% ratio) and normal-for-size graft (≤4% ratio).
- Analysis of demographic, preoperative, intraoperative, and intensive care unit data.
Main Results:
- The large-graft-for-size group (>4%) required more colloid solution, furosemide, blood transfusions, and fresh frozen plasma.
- This group exhibited lower intraoperative pH and PO2, higher blood glucose, and lower body temperature during the neohepatic phase.
- Patients with larger grafts were more prone to intraoperative hypotension, required norepinephrine more frequently, and had higher rates of mechanical ventilation postoperatively.
Conclusions:
- A high graft weight-to-bodyweight ratio is associated with adverse metabolic and hemodynamic changes in pediatric liver transplant patients.
- These findings underscore the importance of selecting appropriately sized grafts to mitigate intraoperative complications and optimize early postoperative recovery.
Objectives:
To analyze how graft-weight-to-bodyweight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters.
Materials And Methods:
We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio ≤ 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters.
Results:
Patients in the large-graft-for-size group (>4%) received more colloid solution (57.7 ± 20.1 mL/kg vs 45.1 ± 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 ± 0.6 mg/kg vs 0.4 ± 0.7 mg/kg; P = .018). They had lower mean pH (7.1 ± 0.1 vs 7.2 ± 0.1; P = .004) and PO2 (115.4 ± 44.6 mm Hg vs 147.6 ± 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 ± 96.9 mg/dL vs 262.8 ± 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 ± 0.7°C vs 35.2 ± 0.6°C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 ± 24.3 mL/kg vs 18.8 ± 21.8 mL/kg; P = .013) and neohepatic (17.7 ± 20.4 mL/kg vs 10.3 ± 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 ± 17.6 mL/kg vs 6.2 ± 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intraoperatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05).
Conclusions:
High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.
