Fluid balance in pediatric postoperative liver transplant recipients.

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Abstrakt

Tytuł:: Fluid balance in pediatric postoperative liver transplant recipients.
Autorzy:: Winters JM; Division of Critical Care, Connecticut Children's, University of Connecticut School of Medicine, Hartford, Connecticut, USA.
Brocks R; Division of Pediatric General Surgery, Hospital Sainte-Justine - Mother-Child University Hospital Center, University of Montréal, Québec, Canada.
Chapin CA; Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Lemoine CP; Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Superina R; Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Brandt KA; Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Sanchez-Pinto LN; Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Barhight MF; Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Źródło:: Pediatric transplantation [Pediatr Transplant] 2023 Jun; Vol. 27 (4), pp. e14499. Date of Electronic Publication: 2023 Mar 23.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Copenhagen ; Malden, MA : Munksgaard, c1997-
MeSH Terms:: Liver Transplantation*
End Stage Liver Disease*/surgery
End Stage Liver Disease*/complications
Child ; Humans ; Infant ; Retrospective Studies ; Length of Stay ; Severity of Illness Index ; Respiration, Artificial ; Water-Electrolyte Balance ; Intensive Care Units, Pediatric ; Postoperative Complications/etiology ; Critical Illness
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Contributed Indexing:: Keywords: fluid overload; fluid therapy; pediatric intensive care unit; postoperative management; solid organ transplant
Entry Date(s):: Date Created: 20230323 Date Completed: 20230517 Latest Revision: 20230522
Update Code:: 20240105
DOI:: 10.1111/petr.14499
PMID:: 36951112
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Background: Positive fluid balance (FB) is associated with poor outcomes in critically ill children but has not been studied in pediatric liver transplant (LT) recipients. Our goal is to investigate the relationship between postoperative FB and outcomes in pediatric LT recipients.
Methods: We performed a retrospective cohort study of first-time pediatric LT recipients at a quaternary care children's hospital. Patients were stratified into three groups based on their FB in the first 72 h postoperatively: <10%, 10-20%, and > 20%. Outcomes were pediatric intensive care unit (PICU) and hospital length of stay, ventilator-free days (VFD) at 28 days, day 3 severe acute kidney injury, and postoperative complications. Multivariate analyses were adjusted for age, preoperative admission status, and Pediatric Risk of Mortality (PRISM)-III score.
Results: We included 129 patients with median PRISM-III score of 9 (interquartile range, IQR 7-15) and calculated Pediatric End-stage Liver Disease score of 15 (IQR 2-23). A total of 37 patients (28.7%) had 10-20% FB, and 26 (20.2%) had >20% FB. Greater than 20% FB was associated with an increased likelihood of an additional PICU day (adjusted incident rate ratio [aIRR] 1.62, 95% CI: 1.18-2.24), an additional hospital day (aIRR 1.39, 95% CI: 1.10-1.77), and lower likelihood of a VFD at 28 days (aIRR 0.85, 95% CI: 0.74-0.97). There were no differences between groups in the likelihood of postoperative complications.
Conclusions: In pediatric LT recipients, >20% FB at 72 h postoperatively is associated with increased morbidities, independent of age and severity of illness. Additional studies are needed to explore the impact of fluid management strategies on outcomes.
(© 2023 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.)

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