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Key Aspects of Pediatric Liver Transplant Patient Visits to the Pediatric Emergency Department
Ayşe Gültekingil1, Mikail Hamza Yücel, Özlem Temel
1From the Department of Pediatrics, Division of Pediatric Emergency Medicine, Baskent University Medical Faculty, Ankara, Turkey.
Insights
Pediatric liver transplant patients frequently visit the emergency department for common illnesses, with about half requiring hospitalization. Seizures and sepsis are key risk factors for pediatric intensive care unit admission in these vulnerable patients.
Area of Science:
- Pediatric Gastroenterology
- Transplant Hepatology
- Emergency Medicine
Background:
- Liver transplant recipients can experience acute and chronic complications.
- Pediatric liver transplant patients may require emergency department (ED) care for transplant-related issues.
- Identifying risk factors for intensive care unit (ICU) admission is crucial for managing these patients.
Purpose of the Study:
- To describe the clinical characteristics of pediatric liver transplant patients presenting to the ED.
- To identify risk factors associated with pediatric intensive care unit (PICU) admission in this population.
Main Methods:
- Retrospective evaluation of pediatric liver transplant patients admitted to the ED in 2023.
- Analysis of patient symptoms, laboratory results, hospitalization status, and diagnoses.
- Comparison of clinical and laboratory features between patients admitted to the ICU and those not admitted.
Main Results:
- 108 ED visits from 33 pediatric liver transplant patients were analyzed.
- Common presentations included vomiting, fever, and respiratory symptoms; 45.4% of visits led to hospitalization.
- Seizures and sepsis significantly correlated with ICU admission (P <.001), with earlier posttransplant time being a risk factor.
Conclusions:
- Half of pediatric liver transplant patients presenting to the ED require hospitalization, often for supportive care.
- While ICU admissions are infrequent, physicians must monitor for serious complications, particularly early posttransplant.
- Close monitoring is essential due to intensive immunosuppressive therapy regimens used in early posttransplant care.
Objectives:
Patients with liver transplant can present to a pediatric emergency department with short- and long-term complications of transplant. Here, we described clinical features of pediatric liver transplant patients admitted to the pediatric emergency department and identified risk factors that may lead to pediatric intensive care unit admission.
Materials And Methods:
We retrospectively evaluated pediatric liver transplant patients admitted posttransplant to Baskent University Hospital's pediatric emergency department in 2023. We noted symptoms, laboratory tests, hospitalization status, and final diagnoses. We compared clinical and laboratory features of patients admitted or not admitted to the intensive care unit.
Results:
In 2023, 108 presentations of 33 liver transplant patients presented to our pediatric emergency department: 46.3% were girls, mean age was 7.79 ± 4.40 years, and median posttransplant day at time of emergency department visit was 622 days. Common symptoms were vomiting (48%), fever (46%), and rhinorrhea and cough (34%). Forty-nine visits (45.4%) resulted in hospitalization; 5 visits (4.6%) resulted in PICU admission, with 2 mortalities (1.8%). Final diagnoses included acute gastroenteritis and upper respiratory tract infections (23 patients) and lower respiratory tract infections (13 patients). Seven patients had cholangitis, 6 had intra-abdominal infection, and 5 had sepsis. Seizures and sepsis were significantly correlated with intensive care unit admission (P <.001). Patients admitted to the intensive care unit had significantly shorter time posttransplant versus other patients (518 ± 324 vs 1498 ± 1658 days; P < .001).
Conclusions:
Half of patients who presented to the emergency department required hospitalization mainly for observation and supportive treatment, with a small number requiring intensive care unit admission. Nevertheless, physicians caring for liver transplant patients should be aware of serious complications and monitor patients closely, especially early posttransplant when intensive immunosuppressive treatment regimens are used.
