Pediatric Liver Transplantation: A Single-Center Experience in the Intensive Care Unit

Liver transplantation is the only definitive treatment for end-stage liver disease in children. Advances in surgical techniques, immunosuppression, and perioperative management have improved survival. This study evaluates outcomes of pediatric liver transplantation at a single center in Türkiye, focusing on complication rates, survival, and factors influencing mortality.

This retrospective study included all pediatric patients (<18 years) who underwent liver transplantation between 2015 and 2023. Data on demographics, primary liver diseases, postoperative complications, PICU course, retransplantation, and mortality were collected. Descriptive analyses, group comparisons, and multivariate logistic regression were performed to identify independent mortality predictors.

A total of 140 children were evaluated; median age at transplantation was 23 months. Biliary atresia was the most common indication (45.7%), followed by metabolic diseases (22.1%). Postoperative complications occurred in 42.1% of patients: infectious (35%), biliary (15.7%), and gastrointestinal (15%). Vascular complications were seen in 8.6%, and acute rejection in 10.7%. Retransplantation was required in 5%. Overall mortality was 14.3%. Sepsis was the leading cause of death (35%), followed by central nervous system complications (25%). Prolonged PICU stay emerged as the only independent predictor of mortality, with each additional day increasing risk by 6%.

Outcomes at the center align with international data, demonstrating acceptable complication and survival rates. The prominence of infectious and neurological complications underscores the need for strong infection-control measures, early detection of deterioration, and optimized intensive care. Future studies should evaluate long-term graft function and quality of life.