Factors associated with postoperative respiratory conditions and critical outcomes on pediatric liver transplantation: A single-center experience

Abstract

Background: Orthotopic liver transplantation (OLT) is an established therapeutic option for pediatric end-stage liver disease (PELD). The postoperative respiratory conditions of OLT recipients may be associated with subsequent clinical outcomes including length of stay (LOS) in the pediatric intensive care unit (PICU). This study aimed to characterize the postoperative respiratory conditions, associated factors, and outcomes after pediatric OLT. Methods: Clinical data of children receiving OLT from July 2014 to July 2020 were retrospectively collected. Postoperative respiratory conditions were defined as time to extubation, significant pleural effusion, and initial postoperative PaO2/FiO2 ratio. Logistic and multiple regressions were applied to analyze the associations among clinical factors, postoperative respiratory conditions, and clinical outcomes. Results: Twenty-two patients with median age of 1.4-year-old (range: 25 days to 12 years old) were analyzed. Mortality within 28 days was 4.5% and median LOS in the PICU was 18 days. Of 22 patients, 11 patients (50.0%) were extubated over 24 hours after surgery, and 8 patients (36.4%) required drainage for pleural effusions. Longer LOS in the PICU were noted in patients extubated over 24 hours (p = 0.008), complicated with significant pleural effusions (p = 0.02) after surgery, and having low initial postoperative PaO2/FiO2 (<300 mmHg) (p = 0.001). Among clinical factors, massive intraoperative blood transfusion (>40 mL/kg) was significantly associated with prolonged intubations, significant pleural effusions, low initial postoperative PaO2/FiO2, and prolonged LOS in the PICU (>14 days). The initial postoperative PaO2/FiO2 significantly depended on age, disease severity (PELD score), and whether the patient received massive intraoperative blood transfusion. Conclusion: Pediatric patients of OLT with poor postoperative respiratory conditions including low initial PaO2/FiO2 ratio, extubation over 24 hours or significant pleural effusions have longer LOS in the PICU, and the requirement of massive intraoperative transfusion was a risk factor for both poor postoperative respiratory conditions and prolonged LOS in the PICU.

Association between serum HMGB1 elevation and early pediatric acute respiratory distress syndrome: a retrospective study of pediatric living donor liver transplant recipients with biliary atresia in China

“…As a result, children are more vulnerable to perioperative lung injury than adults. Although studies have suggested that pretransplant PELD scores are associated with postoperative outcome indicators after liver transplantation [ 12 , 34 ], it was not observed in our study. This may be partly due to differences in study populations, clinical trial conditions, and surgical techniques.…”

Blood urea nitrogen and creatinine in in-hospital cardiac arrest patients

“…Therefore, more powerful and accurate biomarkers and/or clinical parameters are urgently needed to determine what situations may be associated with mortality as well as with developing post-resuscitation morbidity while surviving. [3][4][5] In theory, similar to all other diseases, [5][6][7][8][9] an early identification of risk factors associated with IHCA and an offering the prompt and effective treatment may decrease the IHCA -related morbidity and mortality. The recent publication in the last October issue of the Journal of the Chinese Medical Association entitled "Prognostic significance of the blood urea nitrogen to creatinine ratio in in-hospital cardiac arrest after targeted temperature management," attempted to use the simple parameters of blood urea nitrogen (BUN) to creatinine (Cr) ratio (BCR) to predict the neurological outcome at discharge among IHCA patients receiving targeted temperature management (TTM).…”