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Postoperative Risk Factors and Outcome of Patients With Liver Transplantation Who Were Admitted to Pediatric
Juan Qian1, Tao Zhou2, Bi-Jun Qiu2
1Pediatric Intensive Care Unit, 71140Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.
Insights
Pediatric liver transplant recipients admitted to the pediatric intensive care unit (PICU) face significant risks, with pulmonary and surgical complications being most common. Interdisciplinary cooperation is key to improving outcomes for these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Transplant surgery
Background:
- Liver transplantation (LT) in children is complex, requiring specialized intensive care.
- Pediatric intensive care unit (PICU) management presents unique challenges for post-LT patients.
Purpose of the Study:
- To review 10 years of pediatric intensive care unit (PICU) management for pediatric liver recipients.
- To assess the impact of interdisciplinary cooperation between two hospitals on patient outcomes.
Main Methods:
- Retrospective chart review of pediatric liver transplant recipients admitted to the PICU.
- Analysis of data from a pediatric liver transplant database and hospital medical records.
Main Results:
- Of 767 liver transplants, 97 patients required PICU admission for post-transplant complications.
- Pulmonary (53.6%) and surgical (22.7%) complications were most frequent; 28-day PICU mortality was 25.8%.
- Surgical complications significantly increased mortality (54.5% vs 17.3%); Pediatric Risk of Mortality III score was an independent prognostic factor.
Conclusions:
- Pediatric liver transplant recipients experience diverse complications requiring intensive care.
- Effective interdisciplinary cooperation is crucial for optimizing outcomes in pediatric liver transplant patients in China.
Introduction:
The aim of this study was to present our 10-year experience of pediatric intensive care unit (PICU) management with pediatric liver recipients and to understand the importance of close interdisciplinary cooperation in 2 hospitals.
Methods:
A retrospective chart review study was performed according to our hospital's medical records and the pediatric liver transplant database of Renji hospital.
Results:
A total of 767 patients received liver transplantation (LT) performed in Renji hospital between October 2006 and December 2016, of which 97 of them were admitted to PICU in our center for various complications developed after transplantation. 8.8% (16/208) and 14.4% (81/559) of patients were transferred to PICU in stages I and II, respectively, and was comparable in the 2 stages (P = .017). The majority of patients was late postoperative children (median 185 post-LT days) in stage I. More patients were transferred to PICU directly in stage II. PICU admitted more younger (median 8.2 months) and early postoperative patients in stage II. The median length of PICU stay was 11.0 (6.0-20.5) days. The median length of mechanical ventilation was 5.0 (0.0-12.0) days. The most frequent complications were pulmonary complications (52 [53.6%] patients), surgical complications (22 [22.7%] patients), sepsis (7 [7.2%]), and other miscellaneous complications (16 [16.5%] patients). The overall 28-day PICU mortality was 25.8% (n = 25) and 64.0% (n = 16) of the deaths happened in the early postoperative period. There was significant difference concerning mortality in children with surgical complications and medical problems (54.5% [12/22] vs 17.3% [13/75], P = .001). Multivariate analysis by regression showed that the pediatric risk of mortality III score was the only independent prognostic factor (P = .031).
Conclusions:
Multiple complications occur in children with LT. Although challenging, interdisciplinary cooperation between different hospitals is an effective mean to enable children to maximize the benefit gained from LT in China.
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