The Research Of Early Post-operative Complications And Growth After Pediatric Liver Transplantation

Objective: To research the incidence of early post-operative complications after pediatric liver transplantation, the risk factors of early post-operative complications and the impact of early post-operative complications on recipient survival. To analyze nutritional status in the pre-transplantation period, and post-transplantation growth and associated factors in pediatric recipients.Methods: In this study, data were collected as follows:(1) the recipient information: age, gender, height, weight, diagnosis, pre-operative TBIL level, pre-operative INR, whether accept the Kasai surgery before LT;(2) the donor information: age, weight;(3)the information about graft and surgery: cold ischemia time, warm ischemia time, the weight of the graft, Graft to Recipient Weight Ratio, date, length of surgery, blood loss volume, transfusion of red blood cells volume;(4) post-operative information: ventilator time, the time of ICU, the incidence of early post-operative complications, follow-up time, survival rate of recipients, time of death, cause of death, height and weight before transplantation and postoperatively at the 6th month and 1st, 2nd, 3rd, 4th, and 5th year. Children with end-stage liver disease treated by the same group between September 2006 and December 2014 were included in the study. To analyze the incidence of early post-operative complications and survival after pediatric liver transplantation. Unconditional logistic regression was used to analyze the risk factors of early post-operative complications. Kaplan-Meier univariate analysis and COX multivariate analysis were used to analyze of risk factors for post-operative dead recipients. Referring to data surveying on physical development of children in nine municipalities, Z score was used to evaluate physical growth and development after liver transplantation. When P <0.05 considered statistically significant.Results: The study of post-operative complications: 214 children with end-stage liver disease were included in the study, of which 111 were males(51.87 %), 103 females(48.13 %). The median of age at transplant was 10 months(4-183 months). Biliary atresia was the main indication for transplantation(191 cases;89.25 %). The others were Wilson disease( 4 cases;1.87 %), hyperammonemia(3 cases;1.40 %), idiopathic portal hypertension(2 cases;0.93 %) and so on. 140 children(65.42 %) received LDLT, 50 children(23.36 %) received DCD whole liver transplantation, and 20 children(9.35 %) received split liver transplantation. 51 recipients had early surgical complications. Hepatic artery thrombosis occurred in 11(5.14 %), portal vein thrombosis in 5(2.34 %), bile leakage in 15(7.01 %), bleeding in 6(1.40 %), chylous leakage in 14(6.54 %). 74 recipients had early non-surgical complications,including 56 cases of infection(26.17 %), 14 cases of rejection(6.54 %) and so on. Regression analysis show that if the volume of red blood cell transfused intra-operative > 750 ml, the risk of early post-operative complications and bile leakage increase, if the weight of recipient <6.65 Kg, the risk of early post-operative vascular complications increases. if the GRWR> 3.17 % or non-LDLT, the risk of early post-operative hepatic artery complications increases; if the surgery length> 507 minutes, risk of post-operative complications of portal vein increases. Kaplan-Meier univariate and multivariate survival analysis COX risk factors for early postoperative deaths in children are shown for bleeding(P = 0.026), infection(P = 0.022) bile leakage(P = 0.03).The study of growth after liver transplantation: 70 children with complete follow-up data of growth were included in the study, of which 42 were males(60 %), 28 females(40 %). The median of age at transplant was 10 months(6-69 months). Biliary atresia was the main indication for transplantation(66 cases;94.28 %). The others were Wilson disease( 1 cases;1.43 %), hyperammonemia(2 cases;2.86 %), idiopathic portal hypertension(2 cases;0.93 %) and congenital hepatic fibrosis(one case;1.43 %). 55 children(78.57 %) received LDLT, 6 children(8.57 %) received DCD whole liver transplantation, and 9 children(12.86 %) received split liver transplantation. Patients’ ZH and ZW scores at liver transplantation were-1.64 ±1.34 and-1.54 ±1.52, respectively. After liver transplantation, the ZH score improved significantly to reach-0.31±1.51 by the end of the first year(P=0.000), the ZW score improved significantly to reach-0.09±1.09 by the end of the first year(P=0.000). After the first year, the z score showed no marked changes. Patients ZH and ZW average scores at liver transplantation and 6 months after liver transplantation were lower than the average level of the growth standard for Chinese children(2005)(P>0.05). Patients ZH and ZW average scores at1 st, 2nd, 3rd, 4th, and 5th year after liver transplantation reached the average level of the growth standard for Chinese children(2005)(P>0.05).Gender, type of donor had no impact on post-transplantation growth.Conclusions: Risk factors for early postoperative complications include recipient body weight(< 6.65kg), donor source(non-living donor), GRWR(> 3.17 %), long-time operation(>507min), intra-operative red blood cell transfusions(> 750ml). Early postoperative complications, especially bleeding, bile leakage, infection is a risk factor for early death postoperatively. Children have the potential ability to catch up in growth to normal levels after liver transplantation. Children show impressive height and weight gain in the first year.