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Published on: December 1, 2012
Retrospective Cohort Study of Associated Factors for Intestinal Complications in Pediatric Liver Transplantation
Sindy Pires1, Valérie A McLin1,2, Nathalie Rock1,2
1Swiss Pediatric Liver Center, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
Insights
Intestinal complications affect 11% of pediatric liver transplant recipients, leading to increased morbidity. Poor pre-transplant nutritional status and intraoperative intestinal injury are key risk factors for these serious adverse events.
Area of Science:
- Pediatric surgery
- Hepatology
- Gastroenterology
Background:
- Intestinal complications (IC) are serious adverse events following liver transplantation (LT).
- Limited research exists on IC in pediatric LT cohorts.
- This study addresses the knowledge gap by describing IC in children post-LT and identifying associated factors.
Purpose of the Study:
- To characterize the incidence and types of intestinal complications (IC) after pediatric liver transplantation (LT).
- To identify pre-, peri-, and postoperative factors associated with the development of IC in pediatric LT recipients.
Main Methods:
- Retrospective review of 153 pediatric patients (0-18 years) who underwent LT at the Swiss Pediatric Liver Center.
- Analysis of pre-, peri-, and postoperative data to identify risk factors for IC.
- IC defined as pathologies or lesions directly associated with LT and attributable to the surgical procedure.
Main Results:
- 11% of pediatric LT patients (16/153) developed IC, including mechanical obstructions, intestinal perforations, and abscesses.
- IC was associated with lower Body Mass Index (BMI), prior Kasai hepatoportoenterostomy with Ladd procedure, intraoperative intestinal perforation, and prolonged LT duration.
- Patients with IC required more post-LT parenteral nutrition and underwent more reoperations.
Conclusions:
- Intestinal complications occur in approximately 1 in 10 children post-LT, contributing to significant morbidity.
- Pre-LT nutritional status and intraoperative factors like adhesiolysis and prolonged surgery are associated with IC.
- Early diagnosis and awareness of these factors are crucial for managing pediatric LT patients.
Background:
Intestinal complications (IC) represent serious adverse events after liver transplantation (LT), however limited research has been conducted in pediatric cohorts. This study aims to describe IC after pediatric LT and to identify associated factors.
Methods:
Retrospective review of 153 patients having undergone LT, aged 0-18 years, treated in the Swiss Pediatric Liver Center in Geneva. Pre-, per- and postoperative data were analyzed. IC were defined as pathologies or lesions directly associated with LT and attributable to the surgical procedure.
Results:
16/153 (11%) patients developed IC: 10/16 mechanical obstructions, 4/16 intestinal perforations and 2/16 sub-mesocolic abscesses. IC patients had a significantly lower Body Mass Index (BMI) (15.5 vs. 16.4, p = 0.019). Children with IC had significantly higher incidence of previous Kasai hepatoportoenterostomy associated with Ladd procedure (13% vs. 2%, p = 0.055), a history of intraoperative iatrogenic intestinal perforation(s) (31% vs. 5%, p = 0.003) and prolonged LT surgery duration (536 vs. 415 min, p = 0.007). Significantly more children with IC had received basiliximab (69% vs. 40%, p = 0.048). Patients with IC exhibited a higher incidence of post-LT sub-occlusions (p < 0.001) and an increased requirement for post-LT parenteral nutrition (p = 0.027). Additionally, IC patients underwent significantly more reoperations (p < 0.001).
Conclusion:
One in 10 children post-LT experiences IC, which are associated with significant morbidity. Pre-LT nutritional status appears as an associated factor with IC, along with the necessity for adhesiolysis during LT, often leading to prolonged operative time. These associated factors should alert medical teams to promote early IC diagnosis in patients after LT.
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