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Respiratory Complications Following Pediatric Liver Transplantation: Frequency, Risk Factors, and Clinical Predictors
Fusun Unal1, Burcu Saka2, Fatma Nur Ayman3
1Division of Pediatric Pulmonology, Başakşehir Çam Sakura City Hospital, Istanbul, Turkey.
Insights
Respiratory complications are common after pediatric liver transplants (LT). Pre-existing conditions like ascites and prior surgeries increase risk, highlighting the need for early identification and intervention to improve outcomes.
Area of Science:
- Pediatric Surgery
- Transplant Hepatology
- Pulmonology
Background:
- Postoperative respiratory complications (PTRCs) are a significant concern in pediatric liver transplant (LT) recipients.
- Understanding the incidence, characteristics, and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, characteristics, and risk factors of PTRCs in pediatric LT recipients.
- To identify clinical predictors of chronic respiratory morbidity following LT.
Main Methods:
- Retrospective analysis of 42 pediatric LT recipients from 2014-2020.
- Assessment of demographics, pre-transplant comorbidities, perioperative factors, and PTRCs.
- Statistical evaluation of associations between clinical features and complications.
Main Results:
- PTRCs occurred in 67% of patients; common complications included pleural effusion, pneumonia, and postextubation respiratory failure.
- Chronic respiratory complications (14%) were linked to prior abdominal surgery, prolonged PICU stay, and postextubation respiratory failure.
- Pre-transplant pneumonia, ascites, portal hypertension, and recurrent abdominal surgery were significant risk factors for PTRCs.
Conclusions:
- Respiratory complications are frequent in pediatric LT recipients.
- Pre-existing pulmonary and intra-abdominal conditions are strongly associated with PTRCs.
- Early identification of at-risk patients can guide perioperative strategies and enhance long-term respiratory health.
Objective:
To investigate the incidence, characteristics, and risk factors of postoperative respiratory complications in pediatric liver transplant (LT) recipients, and to identify clinical predictors of chronic respiratory morbidity.
Methods:
We retrospectively analyzed data from 42 pediatric patients who underwent LT between 2014 and 2020. Variables assessed included demographics, primary liver disease, pre-transplant comorbidities, perioperative factors, and postoperative respiratory complications (PTRCs). Complications were categorized as early or chronic (persisting >3 months). Statistical associations between complications and clinical features were evaluated.
Results:
Postoperative respiratory complications occurred in 67% of patients, with pleural effusion (45%), pneumonia (33%), and postextubation respiratory failure (33%) being most common. Chronic respiratory complications were observed in 14% of patients and were significantly associated with prior abdominal surgery, prolonged pediatric intensive care unit stay, and postextubation respiratory failure. Pre-transplant pneumonia, ascites, portal hypertension, and recurrent abdominal surgery were identified as significant risk factors for PTRCs. Pulmonary hemorrhage was the only complication associated with mortality.
Conclusion:
Respiratory complications are common in pediatric LT recipients and are strongly associated with pre-existing pulmonary and intra-abdominal conditions. Early recognition of at-risk patients may allow for improved perioperative strategies and long-term respiratory outcomes.
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