Jessica Christiano, MD
Pediatric Critical Care Fellow
Ann and Robert H Lurie Childrens Hospital of Chicago
Chicago, Illinois
Disclosure information not submitted.
Rebecca Brocks, MD
Attending Physician, Department of Pediatric Transplant Surgery
Centre Hospitalier Universitaire Sainte-Justine, United States
Disclosure information not submitted.
Catherine A Chapin, MD
Attending Physician, Division of Gastroenterology, Hepatology & Nutrition
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Disclosure information not submitted.
Caroline Lemoine, MD
Attending Physician, Division of Transplant Surgery
Ann & Robert H. Lurie Children's Hospital, United States
Disclosure information not submitted.
Riccardo Superina, MD
Attending Physician, Division Head, Department of Transplant Surgery
Ann & Robert H. Lurie Children's Hospital of Chicago, United States
Disclosure information not submitted.
L. Nelson Sanchez-Pinto, MD, MBI
Assistant Professor of Pediatrics (Critical Care)
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois
Disclosure information not submitted.
Matthew Barhight, MD
Attending Physician, Division of Critical Care
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
Disclosure information not submitted.
Title: Fluid Overload in Pediatric Postoperative Liver Transplant Recipients
Introduction: Fluid overload (FO) is common in critically ill children and is associated with increased morbidity and mortality. Orthotopic liver transplant (LT) patients have unique fluid management goals in the postoperative period. We aimed to determine the frequency of FO and its association with outcomes in pediatric postoperative LT recipients.
Methods: Retrospective cohort study of patients age 0-18 years who received a LT from 2009-2018 at a quaternary care children’s hospital. Patients undergoing repeat LT, initial and repeat LT during same admission, multi-visceral transplant, or who died prior to postoperative day (POD) 3 were excluded. Bivariate and multivariate regression analyses were done to assess the relationship between FO (cumulative fluid balance (CFB) through POD 3 divided by pre-LT weight) and intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days in 28 (VFD), in-hospital mortality, and severe AKI (stage 2 or 3). Analyses were adjusted for a-priori-defined confounders of age, pre-LT location, and PRISMIII score.
Results: Our population consisted of 141 patients, 71 (50.4%) with biliary atresia, median PELD/MELD score of 15 (2-24), and 47 (33.3%) patients were admitted to the hospital prior to LT. Post-LT, there was a median PRISMIII score of 9 (7-14), 10 (7.1%) had hepatic artery and/or portal vein thrombosis, and 31 (22.0%) received >40mL/kg of blood product by POD 3. 70 (49.6%) patients had < 10% CFB, 41 (29.1%) patients had 10-20% CFB, and 30 (21.3%) patients had > 20% CFB. After adjusting for confounders, patients with > 20% CFB on POD 3 were more likely to have an additional ICU day (IRR 1.57, 95% CI: 1.12-2.22), hospital day (IRR 1.33, 95% CI: 1.02-1.73), less likely to have a VFD (IRR 0.81, 95% CI: 0.69-0.97), and had increased odds of day 3 severe AKI (OR 4.12, 95% CI: 1.23-13.82).
Conclusions: FO is common in pediatric LT recipients in the post-operative period. Presence of > 20% CFB on POD 3 is significantly associated with longer ICU LOS, hospital LOS, decreased VFD, and increased frequency of severe AKI, independent of age and severity of illness. Further studies are needed to understand FO in this population and how to modify this risk factor. A prospective study investigating fluid management in the post-operative pediatric LT population is warranted.