Anesthesia for pediatric organ transplantation, current concepts

Although less common than in adults, pediatric organ transplantation has seen significant recent innovations in surgical techniques, perioperative management, and postoperative outcomes. These advances, which we will delve into in this review, are at the forefront of improving the survival and quality of life of pediatric transplant recipients.

Advances in donor utilization (e.g. donation after circulatory death and split-liver grafts) and surgical approaches (partial heart transplants and novel multiorgan procedures) have expanded the donor pool and enhanced graft viability. Improved perioperative care, including refined anesthetic monitoring, fluid management, and immediate extubation, reduces the incidence of complications. Research into model-informed precision dosing for antibiotics addresses under- or overdosing in critically ill children, whereas emerging immunosuppressants offer potential benefits over conventional regimens. Nonetheless, coagulopathy, hemodynamic instability, and developmental variations remain major challenges.

Optimization of pediatric transplantation is a complex task that requires multidisciplinary collaboration. This review underscores the importance of standardizing perioperative protocols, advancing precision medicine, and refining surgical and anesthetic techniques. It also highlights the need for dedicated pediatric transplant registries and multicenter trials to generate robust data, minimize practice variability, and improve outcomes.