Relationship Between Postoperative Acute Kidney Injury and Early Extubation After Pediatric Liver Transplant

Postoperative acute kidney injury after pediatric liver transplant is a serious complication with considerable short-term and long-term consequences. We hypothesized that incidence of postoperative acute kidney injury after pediatric liver transplant is lower among patients extubated early after surgery in the operating room.

In this retrospective cohort study, we reviewed the medical records of all patients aged <18 years who underwent liver transplant from January 2012 to December 2020. Early extubation was defined as extubation in the operating room. Children were divided into 2 groups: those who were extubated in the operating room and those who were extubated in the intensive care unit.

A total of 132 pediatric liver transplant recipients were analyzed. The mean age of transplant was 58.2 ± 60.1 months, and 54.5% were male recipients. Early immediate tracheal extubation in the operating room was performed in 86 patients (65.2%). Postoperative acute kidney injury was seen in 24 children (18.2%) of which 15 (11.4%) had stage 1 acute kidney injury, 8 (6.1%) had stage 2, and 1 (0.8%) had stage 3. There was no statistically significant difference between the 2 groups regarding development of acute kidney injury (18.6% vs 17.4%; P > .05). Compared with patients who were not extubated in the operating room, the need for an open-abdomen procedure (76.9% vs 23.1%; P = .001) was significantly higher in patients who were extubated in the operating room. Durations for length of stay in the intensive care unit and hospital were significantly shorter in patients who were extubated in the operating room (P < .001).

Our results showed that early extubation was performed in nearly two-thirds of our cohort. There was no association between early extubation and development of acute kidney injury among pediatric liver transplant recipients.