Danielle Maue, MD
Assistant Professor of Clinical Pediatrics
Riley Hospital for Children Indiana University
Indianapolis, Indiana
Disclosure information not submitted.
Mercedes Martinez, MD
Professor of Pediatrics and Medicine
Columbia, United States
Disclosure information not submitted.
Fernando Beltramo, MD
Assistant Professor of Pediatrics
Children's Hospital Los Angeles, United States
Disclosure information not submitted.
Alicia Alcamo, MD, MPH
Assistant Professor
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Leslie Ridall, DO
Assistant Professor of Pediatrics
Children's Hospital Colorado At University of Colorado, United States
Disclosure information not submitted.
Michael Nares, MD
Assistant Professor of Clinical Pediatrics
University of Miami Jackson Memorial Medical Center, United States
Disclosure information not submitted.
Asumthia Jeyapalan, DO, MHA
Division of Pediatric Critical Care Medicine
University of Miami Miller School of Medicine, United States
Disclosure information not submitted.
Matthew Zinter, MD
Assistant Professor of Pediatrics
University of California San Francisco Medical Center, United States
Disclosure information not submitted.
Kristina Betters, MD
Assistant Professor of Pediatrics
Vanderbilt University
Nashville, Tennessee
Disclosure information not submitted.
Sameer Kamath, MD
Associate Professor of Pediatrics
Duke University, United States
Disclosure information not submitted.
Alexandra Monde, MD
Assistant Professor of Pediatrics
Georgetown University, United States
Disclosure information not submitted.
Shubhi Kaushik, MD
Assistant Professor of Pediatrics
Mount Sinai Kravis Children's Hospital, United States
Disclosure information not submitted.
Joseph Resch, MD
Critical Care Fellow
University of Minnesota, United States
Disclosure information not submitted.
Elise Kang, MD
Pediatric Gastroenterology Fellow
Columbia University, United States
Disclosure information not submitted.
Francis Pike, PhD, MSC, BSC
Associate Research Professor of Biostatistics and Health Data Sciences
Indiana University School of Medicine, United States
Disclosure information not submitted.
Richard Mangus, MD
Professor of Surgery
Indiana University Department of Surgery, United States
Disclosure information not submitted.
Courtney Rowan, MD
Division of Critical Care, Department of Pediatrics
Riley Hospital For Children at Indiana University Health, Indiana, United States
Disclosure information not submitted.
Title: Predictive factors for Postoperative Mechanical Ventilation in Pediatric Liver Transplant Patients
Introduction: There is a paucity of data on the immediate postoperative course of pediatric liver transplant recipients. In this study, we aimed to determine which characteristics and management approaches were associated with both the occurrence of postoperative mechanical ventilation and with a prolonged course of mechanical ventilation.
Methods: This is a retrospective, multicenter, cohort study of children < 18 years of age who underwent an isolated liver transplant between 2017-2018. Patients were categorized initially by use of postoperative mechanical ventilation on admission and then subcategorized by those who were ventilated more than 24 hours compared to those were extubated within the first 24 hours. Univariate and multivariate regression analyses were conducted.
Results: Data were collected from 330 pediatric liver transplant patients from 12 transplant centers across the United States. There were 239 (72.4%) children who were invasively ventilated postoperatively. A multivariate model was constructed to determine factors associated with use of mechanical ventilation (AUC = 0.78) with the following results: younger age (p< 0.001), open fascia (p < 0.001), and preoperative hospitalization (p=0.018). Of the 239 children who received invasive ventilation postoperatively, 61.1% (n-146) were ventilated for >24 hours. A multivariate model was built to determine factors associated with mechanical ventilation > 24 hours (AUC = 0.74) with the following results: postoperative day 0 peak inspiratory pressure (PIP) (p < 0.001) and younger age (p < 0.001). Length of mechanical ventilation > 24 hours was associated with bleeding complications [aOR 3.08 (95% CI: 1.13, 8.40), p=0.03], postoperative infections [aOR 1.68 (95% CI: 1.04, 2.70), p=0.03], graft loss [aOR 19.88 (95% CI: 1.71, 231.84), p=0.02], and return trips to the operating room [aOR 1.67 (95% CI: 1.06, 2.63), p=0.03]. There were 6 deaths in our cohort (1.8%).
Conclusions: Younger age, preoperative hospitalization, and open fascia are associated with use of mechanical ventilation and younger age and postoperative day 0 PIP are associated with mechanical ventilation > 24 hours on multivariate analysis. Mortality rate in this cohort is low, but longer mechanical ventilation is associated with other negative outcomes, thus making it an important clinical marker.