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Fluid balance in pediatric postoperative liver transplant recipients
Jessica M Winters1, Rebecca Brocks2, Catherine A Chapin3
1Division of Critical Care, Connecticut Children's, University of Connecticut School of Medicine, Hartford, Connecticut, USA.
Insights
Positive fluid balance (FB) in pediatric liver transplant (LT) recipients is linked to worse outcomes. Greater than 20% FB post-surgery increases intensive care unit and hospital stays, impacting recovery for these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Transplant surgery
- Nephrology
Background:
- Positive fluid balance (FB) is a known predictor of adverse outcomes in critically ill children.
- This association has not been previously investigated in pediatric liver transplant (LT) recipients.
- Understanding FB's impact is crucial for optimizing care in this vulnerable population.
Purpose of the Study:
- To examine the relationship between postoperative FB and patient outcomes in pediatric LT recipients.
- To identify specific FB thresholds associated with increased morbidity.
- To inform fluid management strategies in pediatric liver transplantation.
Main Methods:
- Retrospective cohort study of first-time pediatric LT recipients.
- Patients stratified by FB in the first 72 hours postoperatively (<10%, 10-20%, >20%).
- Outcomes analyzed include PICU/hospital length of stay, ventilator-free days, and acute kidney injury, adjusted for illness severity.
Main Results:
- A FB >20% was associated with increased PICU and hospital length of stay.
- Higher FB levels correlated with a lower likelihood of ventilator-free days at 28 days.
- No significant differences in postoperative complications or severe acute kidney injury were observed between groups.
Conclusions:
- In pediatric LT recipients, a postoperative FB exceeding 20% at 72 hours is linked to increased morbidity.
- These findings are independent of patient age and initial illness severity.
- Further research into targeted fluid management strategies is warranted to improve outcomes.
Background:
Positive fluid balance (FB) is associated with poor outcomes in critically ill children but has not been studied in pediatric liver transplant (LT) recipients. Our goal is to investigate the relationship between postoperative FB and outcomes in pediatric LT recipients.
Methods:
We performed a retrospective cohort study of first-time pediatric LT recipients at a quaternary care children's hospital. Patients were stratified into three groups based on their FB in the first 72 h postoperatively: <10%, 10-20%, and > 20%. Outcomes were pediatric intensive care unit (PICU) and hospital length of stay, ventilator-free days (VFD) at 28 days, day 3 severe acute kidney injury, and postoperative complications. Multivariate analyses were adjusted for age, preoperative admission status, and Pediatric Risk of Mortality (PRISM)-III score.
Results:
We included 129 patients with median PRISM-III score of 9 (interquartile range, IQR 7-15) and calculated Pediatric End-stage Liver Disease score of 15 (IQR 2-23). A total of 37 patients (28.7%) had 10-20% FB, and 26 (20.2%) had >20% FB. Greater than 20% FB was associated with an increased likelihood of an additional PICU day (adjusted incident rate ratio [aIRR] 1.62, 95% CI: 1.18-2.24), an additional hospital day (aIRR 1.39, 95% CI: 1.10-1.77), and lower likelihood of a VFD at 28 days (aIRR 0.85, 95% CI: 0.74-0.97). There were no differences between groups in the likelihood of postoperative complications.
Conclusions:
In pediatric LT recipients, >20% FB at 72 h postoperatively is associated with increased morbidities, independent of age and severity of illness. Additional studies are needed to explore the impact of fluid management strategies on outcomes.
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