Intensive care management after pediatric liver transplantation: A single‐center experience

Abstract

A retrospective study was conducted to determine the significance of intensive care management on outcome after liver transplantation (LTx) in children. Of 195 transplants performed in 162 children, factors affecting morbidity and mortality were documented during the post-operative intensive care unit (ICU) stay. To assess the gain in experience of ICU management, we compared mean ventilation time and stay in the ICU as well as mortality, incidence of surgical complications, infections, and rejection episodes, during three different time-periods (October 1991-August 1994, September 1994-July 1996, and August 1996-February 1998). The time spent by patients in the ICU (9.7 days vs. 7.9 days vs. 4.7 days, p < 0.001) and time on ventilation (5.2 days vs. 3.1 days vs. 1.2 days, p < 0.001) were significantly reduced over the duration of the study. The overall mortality was 18.0% (n = 30) and 76.7% (n = 23) of these deaths occurred during the early post-operative period in the ICU. The incidence of severe surgical complications decreased significantly over time, and the application of intra-operative Doppler ultrasound since 1994 led to detection of 27 correctable vascular complications. The overall incidence of acute cellular rejection episodes in our center was 64.1%: 43.5% of the infectious episodes occurred in the ICU (bacterial 70.2%, viral 12.3%, and fungal 17.5%). The main side-effect from immunosuppressive drugs was arterial hypertension in 29% of the patients. We conclude that our efforts to improve intensive care management and monitoring were the key elements in reducing morbidity and mortality after pediatric LTx.

Factors Associated with Postoperative Prolonged Mechanical Ventilation in Pediatric Liver Transplant Recipients

“…We found, as did previous investigators [16, 17], that one-year posttransplant death rate among patients requiring PPMV was higher than that in those who are not. It must be noted though that it is impossible to determine a causal relationship between PPMV and mortality from retrospective case-control data such as that we used in the present report.…”

Postoperative care in pediatric liver transplantation

“…Over 70% of patients present with hypertension, which often requires drug-based treatment (5). The cause of this hypertension is multifactorial, involving volume overload, elevated renin levels, and the use of steroids and calcineurin inhibitors.…”

Living Related Liver Transplantation for Biliary Atresia in the Last 5 years: Experience from the First Liver Transplant Program in India

“…Current options for the management of BA include a Kasai portoenterostomy as soon as possible after birth to restore biliary drainage with salvage LT in case of failed Kasai (total serum bilirubin>6 mg/dl more than 3 mo after Kasai) or LT as primary therapy. The advent of newer surgical techniques and better immunosuppressant medications has tremendously improved the survival rates in these patients over the past three decades [7][8][9]. Previously LT was available only in the developed world but over the past decade and a half, it has become established in India [10,11].…”