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Purpose <p>This study aimed to investigate the relationship between postoperative fluid balance (FB) and clinical outcomes in pediatric living-donor liver transplant (LDLT) recipients.</p> Methods <p>This retrospective study was conducted at a tertiary care center. Patients aged ≤ 18&#xa0;years who underwent LDLT between January 2010 and September 2023 were included. Postoperative FB was calculated as [(total fluid intake—total fluid output) / body weight] × 100 for 48&#xa0;h. Patients were categorized into four groups: &lt; 5%, 5–10%, 10–15%, and ≥ 15% FB. The primary outcome was ventilator-free days (VFD) within 30&#xa0;days post-transplantation. Secondary outcomes included acute kidney injury (AKI), reintubation, hepatic arterial thrombosis, acute rejection, primary graft dysfunction, intensive care unit (ICU) length of stay (LOS), and mortality.</p> Results <p>The study included 200 patients with a median weight of 9.0 (interquartile range [IQR]: 6.9–19.3) kg. Median VFD did not significantly differ across the FB groups: &lt; 5% FB, 29.3 (IQR, 28.3–29.4) days; 5–10% FB, 29.3 (IQR, 28.3–29.4) days; 10–15% FB, 29.3 (IQR, 28.3–29.4) days; and ≥ 15% FB, 27.4 (IQR, 23.3–29.4) days (<i>p</i> = 0.27). However, multivariable analysis showed ≥ 15% FB was associated with 4.59&#xa0;days shorter VFD (<i>p</i> = 0.004) and higher AKI incidence (odds ratio: 6.60, <i>p</i> = 0.012). Thrombosis occurred in 7 patients (3.5%) with no significant differences among groups (<i>p</i> = 0.61). Other secondary outcomes showed no significant differences.</p> Conclusion <p>Excessive postoperative FB (≥ 15%) in pediatric LDLT recipients was significantly associated with reduced VFD and increased AKI incidence, whereas other adverse outcomes were not significantly affected.</p>

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Postoperative fluid balance and outcomes in pediatric living-donor liver transplant recipients: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年5月24日

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  • Yotaro Hanami,
  • Satoshi Kimura,
  • Takenori Suga,
  • Tatsuya Okamoto,
  • Eri Ogawa,
  • Kazushige Ashina,
  • Natsumi Nakamura,
  • Shinichi Kai,
  • Hideaki Okajima,
  • Etsuro Hatano,
  • Moritoki Egi,
  • Junko Takita

摘要

Purpose

This study aimed to investigate the relationship between postoperative fluid balance (FB) and clinical outcomes in pediatric living-donor liver transplant (LDLT) recipients.

Methods

This retrospective study was conducted at a tertiary care center. Patients aged ≤ 18 years who underwent LDLT between January 2010 and September 2023 were included. Postoperative FB was calculated as [(total fluid intake—total fluid output) / body weight] × 100 for 48 h. Patients were categorized into four groups: < 5%, 5–10%, 10–15%, and ≥ 15% FB. The primary outcome was ventilator-free days (VFD) within 30 days post-transplantation. Secondary outcomes included acute kidney injury (AKI), reintubation, hepatic arterial thrombosis, acute rejection, primary graft dysfunction, intensive care unit (ICU) length of stay (LOS), and mortality.

Results

The study included 200 patients with a median weight of 9.0 (interquartile range [IQR]: 6.9–19.3) kg. Median VFD did not significantly differ across the FB groups: < 5% FB, 29.3 (IQR, 28.3–29.4) days; 5–10% FB, 29.3 (IQR, 28.3–29.4) days; 10–15% FB, 29.3 (IQR, 28.3–29.4) days; and ≥ 15% FB, 27.4 (IQR, 23.3–29.4) days (p = 0.27). However, multivariable analysis showed ≥ 15% FB was associated with 4.59 days shorter VFD (p = 0.004) and higher AKI incidence (odds ratio: 6.60, p = 0.012). Thrombosis occurred in 7 patients (3.5%) with no significant differences among groups (p = 0.61). Other secondary outcomes showed no significant differences.

Conclusion

Excessive postoperative FB (≥ 15%) in pediatric LDLT recipients was significantly associated with reduced VFD and increased AKI incidence, whereas other adverse outcomes were not significantly affected.