Chronic Pain Following Pediatric Liver Transplantation: A Single-Center Prospective Observational Study
Kaoru Tsuboi1, Hajime Uchida2, Norihiko Tsuboi1
1Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
Insights
Chronic postsurgical pain (CPSP) is uncommon in pediatric liver transplant recipients, affecting 5.0% of patients. Female sex was the only factor linked to developing CPSP, highlighting the need for long-term monitoring.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Pain Management
Background:
- Chronic postsurgical pain (CPSP) affects ~20% of children post-surgery, impacting quality of life.
- Data on CPSP prevalence in pediatric liver transplant recipients is limited.
Purpose of the Study:
- To determine the prevalence of CPSP in pediatric liver transplant recipients.
- To identify factors associated with CPSP in this population.
Main Methods:
- A cohort of 242 pediatric liver transplant recipients (age >6 years, >3 months post-transplant) completed questionnaires on pain.
- CPSP was defined as pain >3 months post-surgery with Visual Analog Scale (VAS) ≥3.
- Multivariate analysis was used to identify associated factors.
Main Results:
- The prevalence of CPSP was 5.0% (12/242 patients).
- Female sex was the only factor independently associated with CPSP (OR=2.91).
- Two patients reported interference with daily activities; pain intensity (VAS) was 4.4 for those with CPSP.
Conclusions:
- CPSP prevalence is low in pediatric liver transplant recipients, though underreporting is possible.
- Some patients experience persistent pain years after transplantation, necessitating long-term follow-up.
- Identifying at-risk individuals, such as females, is crucial for targeted interventions.
Background:
Chronic postsurgical pain (CPSP) has been reported in approximately 20% of children across all surgery types 12 months after surgery and is associated with poorer functional outcomes and health-related quality of life. However, data on pediatric liver transplantation recipients are lacking.
Methods:
Among all patients who visited our organ transplantation center outpatient clinic between April 2023 and January 2024, those who met the following criteria were included: (1) had undergone liver transplantation under 18 years of age, (2) older than 6 years on the day of their visit, and (3) more than three months had passed since their last liver transplantation. Prevalence of pain at the surgical site, characteristics of pain, and interference with daily functioning were asked. CPSP was defined as pain persisting over three months post-surgery with intensity rated ≥ 3 on a 10-point visual analog scale (VAS).
Results:
A total of 242 patients returned valid responses; 136 (56.2%) were female. Median age at transplantation was 24 months (IQR 9-86) and 12 years (IQR 9-15) at questionnaire distribution. Thirty-three (13.6%) patients reported pain, of which 12 (5.0%) presented CPSP. Among patients with CPSP, the median value of 'maximum VAS within the past month' was 4.4. Two patients reported interference with daily activities. Multivariate analysis revealed female sex as the only factor independently associated with postsurgical pain (OR = 2.91 [95% CI, 1.24-6.83]).
Conclusions:
Overall prevalence of chronic pain was low; potential underreporting due to cultural backgrounds may be present. However, some patients reported pain persisting years after transplantation, indicating the need for long-term follow-up.
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