Risk factors of pleural effusion in post-liver transplant pediatric population

Pediatric liver transplantation (LT) is curative therapy for end-stage liver disease. One of the most frequent pulmonary complications after LT in children is pleural effusion. With improvement in surgical techniques and postoperative intensive care, long-term survival is now more than 80%. This study was performed to assess the incidence, risk factors, and clinical significance of post-LT pleural effusion in children.

This retrospective cohort study from a single center enrolled 60 children who had undergone liver transplantation in our center from July 2021 to April 2024. Preoperative, perioperative, intraoperative, and postoperative parameters were collected and measured to determine factors related to the development of pleural effusion. Data was entered and analyzed in SPSS ver: 26.0.

Post-liver transplant (LT) pleural effusion occurred in 36/60 pediatric patients (60%). Some important risk factors were found in those patients who had pleural effusion. These were a Pediatric End-Stage Liver Disease (PELD) score of ≥18, malnutrition, and lower preoperative fibrinogen, albumin, and hemoglobin levels. A binary logistic model was used to evaluate risk factors for post operative pleural effusion among patients with postoperative fibrinogen, albumin, protein, INR, APTT, platelets, and Hemoglobin level. Odds ratio for Serum albumin level (B) was 34.545 for developing plural effusion.

Pleural effusion is a frequent postoperative complication in children undergoing liver transplantation and is correlated with greater morbidity, especially in those patients necessitating therapeutic drainage. Preoperative and intraoperative factors can also act as significant predictors and prognostic markers. Early recognition and treatment of these risk factors may be helpful in outcomes.