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Mian MUM, Kennedy CE, Coss-Bu JA, Javaid R, Naeem B, Lam FW, Fogarty T, Arikan AA, Nguyen TC, Bashir D, Virk M, Harpavat S, Galvan NTN, Rana AA, Goss JA, Leung DH, Desai MS. Estimating risk of prolonged mechanical ventilation after liver transplantation in children: PROVE-ALT score. Pediatr Transplant 2024; 28:e14623. [PMID: 37837221 DOI: 10.1111/petr.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/11/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Children at high risk for prolonged mechanical ventilation (PMV) after liver transplantation (LT) need to be identified early to optimize pulmonary support, allocate resources, and improve surgical outcomes. We aimed to develop and validate a metric that can estimate risk for Prolonged Ventilation After LT (PROVE-ALT). METHODS We identified preoperative risk factors for PMV by univariable analysis in a retrospective cohort of pediatric LT recipients between 2011 and 2017 (n = 205; derivation cohort). We created the PROVE-ALT score by mapping multivariable logistic regression coefficients as integers, with cutoff values using the Youden Index. We validated the score by C-statistic in a retrospectively collected separate cohort of pediatric LT recipients between 2018 and 2021 (n = 133, validation cohort). RESULTS Among total 338 patients, 21% (n = 72) were infants; 49% (n = 167) had cirrhosis; 8% (n = 27) required continuous renal replacement therapy (CRRT); and 32% (n = 111) required management in hospital (MIH) before LT. Incidence of PMV post-LT was 20% (n = 69) and 3% (n = 12) required tracheostomy. Independent risk factors (OR [95% CI]) for PMV were cirrhosis (3.8 [1-14], p = .04); age <1-year (8.2 [2-30], p = .001); need for preoperative CRRT (6.3 [1.2-32], p = .02); and MIH before LT (12.4 [2.1-71], p = .004). PROVE-ALT score ≥8 [Range = 0-21] accurately predicted PMV in the validation cohort with 73% sensitivity and 80% specificity (AUC: 0.81; 95% CI: 0.71-0.91). CONCLUSION PROVE-ALT can predict PMV after pediatric LT with a high degree of sensitivity and specificity. Once externally validated in other centers, PROVE-ALT will empower clinicians to plan patient-specific ventilation strategies, provide parental anticipatory guidance, and optimize hospital resources.
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Affiliation(s)
- Muhammad Umair M Mian
- Division of Child Health, University of Missouri School of Medicine, Springfield Clinical Campus, Columbia, Missouri, USA
| | - Curtis E Kennedy
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jorge A Coss-Bu
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ramsha Javaid
- Division of Child Health, University of Missouri School of Medicine, Springfield Clinical Campus, Columbia, Missouri, USA
| | - Buria Naeem
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fong Wilson Lam
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas Fogarty
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ayse A Arikan
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Trung C Nguyen
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Dalia Bashir
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Manpreet Virk
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sanjiv Harpavat
- Department of Pediatrics, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Nhu Thao Nguyen Galvan
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Abbas A Rana
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel H Leung
- Department of Pediatrics, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
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Chiu MZ, Cuenca AG, Koo DC, Hartjes K, Wehrman A, Kim HB, Lee EJ. Metastatic pulmonary calcifications after pediatric liver transplantation. Pediatr Transplant 2024; 28:e14693. [PMID: 38317339 DOI: 10.1111/petr.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pulmonary calcification (PC) is a rare clinical entity observed following liver transplantation (LT). Most often identified in adults or in patients with concomitant renal failure, PC is rarely reported in children. While the clinical course of PC is largely benign, cases of progressive respiratory failure and death have been reported. Additionally, PC may mimic several other disease processes making diagnosis and management challenging. Currently, little is reported regarding the diagnosis, management, and long-term outcomes of children with PC following LT. METHODS We performed a retrospective chart review of patients undergoing LT at our institution between 2006 and 2023. We identified two patients who developed PC following LT. Their diagnosis, clinical course, and long-term outcomes are reported. A literature review of the presentation, diagnosis, management, and outcomes of adult and pediatric patients with PC post-LT was also performed. CONCLUSIONS Pulmonary calcifications are a rare but notable complication after pediatric liver transplantation. Our case series adds to the limited literature on this clinical entity in children but also highlights the fact that effective diagnosis and treatment may be safely accomplished without the use of lung biopsy.
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Affiliation(s)
- Megan Z Chiu
- Department of Surgery, Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alex G Cuenca
- Department of Surgery, Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Donna C Koo
- Department of Surgery, Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kayla Hartjes
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Wehrman
- Division of Gastroenterology, Hepatology, & Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Heung Bae Kim
- Department of Surgery, Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eliza J Lee
- Department of Surgery, Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA
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3
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Ruan W, Galvan NTN, Dike P, Koci M, Faraone M, Fuller K, Koomaraie S, Cerminara D, Fishman DS, Deray KV, Munoz F, Schackman J, Leung D, Akcan-Arikan A, Virk M, Lam FW, Chau A, Desai MS, Hernandez JA, Goss JA. The Multidisciplinary Pediatric Liver Transplant. Curr Probl Surg 2023; 60:101377. [PMID: 37993242 DOI: 10.1016/j.cpsurg.2023.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/29/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Wenly Ruan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Nhu Thao N Galvan
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
| | - Peace Dike
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Melissa Koci
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Marielle Faraone
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Kelby Fuller
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Dana Cerminara
- Department of Pharmacy, Texas Children's Hospital, Houston, TX
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Kristen Valencia Deray
- Department of Pediatrics, Department of Pharmacy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Flor Munoz
- Department of Pediatrics, Department of Pharmacy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Julie Schackman
- Division of Anesthesiology, Perioperative, & Pain Medicine, Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Daniel Leung
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Ayse Akcan-Arikan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Manpreet Virk
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Fong W Lam
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Alex Chau
- Division of Interventional Radiology, Department of Radiology, Edward B. Singleton Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Moreshwar S Desai
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jose A Hernandez
- Division of Interventional Radiology, Department of Radiology, Edward B. Singleton Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Liu Y, Shu H, Wan P, Wang X, Xie H. Neutrophil extracellular traps predict postoperative pulmonary complications in paediatric patients undergoing parental liver transplantation. BMC Gastroenterol 2023; 23:237. [PMID: 37442949 DOI: 10.1186/s12876-023-02744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 03/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Parental liver transplantation (PLT) improves long-term survival rates in paediatric hepatic failure patients; however, the mechanism of PLT-induced postoperative pulmonary complications (PPCs) is unclear. METHODS A total of 133 paediatric patients undergoing PLT were included. Serum levels of NET components, including circulating free DNA (cfDNA), DNA-histone complex, and myeloperoxidase (MPO)-DNA complex, were detected. The occurrence of PPCs post-PLT, prolonged intensive care unit (ICU) stay and death within one year were recorded as the primary and secondary outcomes. RESULTS The overall rate of PPCs in the hospital was 47.4%. High levels of serum cfDNA, DNA-histone complexes and MPO-DNA complexes were associated with an increased risk of PPCs (for cfDNA, OR 2.24; for DNA-histone complex, OR 1.64; and for MPO-DNA, OR 1.94), prolonged ICU stay (OR 1.98, 4.26 and 3.69, respectively), and death within one year (OR 1.53, 2.65 and 1.85, respectively). The area under the curve of NET components for the prediction of PPCs was 0.843 for cfDNA, 0.813 for DNA-histone complexes, and 0.906 for MPO-DNA complexes. During the one-year follow-up, the death rate was higher in patients with PPCs than in patients without PPCs (14.3% vs. 2.9%, P = 0.001). CONCLUSIONS High serum levels of NET components are associated with an increased incidence of PPCs and death within one year in paediatric patients undergoing PLT. Serum levels of NET components serve as a biomarker for post-PLT PPCs and a prognostic indicator.
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Affiliation(s)
- Yaling Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road Suzhou, Jiangsu, China
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Huigang Shu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Ping Wan
- Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaodong Wang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China.
| | - Hong Xie
- Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road Suzhou, Jiangsu, China.
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5
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Shimura K, Matsumoto S, Ide K, Baba C, Nakagawa S, Shoji K, Uchida H, Fukuda A, Sakamoto S, Kasahara M. Rescue venovenous extracorporeal membrane oxygenation for the deterioration of acute respiratory distress syndrome in pediatric liver transplantation. Pediatr Transplant 2022; 26:e14305. [PMID: 35567762 DOI: 10.1111/petr.14305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/24/2022] [Accepted: 04/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Twenty percent of pediatric patients with BA develop ACLF with increased mortality while awaiting LT. Respiratory complications are common in pediatric ACLF and are associated with increased morbidity and mortality. ARDS is the most severe manifestation of acute respiratory failure with considerable risk of mortality. METHODS A 5-month-old girl with post-Kasai BA preoperatively experienced ARDS from RSV infection while awaiting LT. She developed decompensated liver failure with shock, acute kidney injury, coagulopathy, and pulmonary hemorrhage after several episodes of sepsis over the course of 1 month in the PICU. At this stage, RSV was not detected in the patient's tracheal aspirate by real-time polymerase chain reaction. She underwent living donor LT to manage her pre-existing critical state. Following reperfusion during LT, her pre-existing ARDS rapidly deteriorated, which was alleviated by intraoperative VV ECMO. RESULTS Severe respiratory acidosis improved rapidly following ECMO, and LT was completed uneventfully. The patient was successfully weaned off ECMO on POD 3. CONCLUSIONS This is the first pediatric case rescued by the intraoperative application of ECMO during LT. Our case and cumulative evidence suggest that VV ECMO can serve as rescue therapy for perioperative refractory respiratory failure in pediatric LT.
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Affiliation(s)
- Kisho Shimura
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shotaro Matsumoto
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Chiaki Baba
- Division of Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Nakagawa
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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6
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Wu JH, Liu CS, Tsai HL, Su CT, Tang YH, Lee YS, Tsao PC, Yeh YT, Chen WY, Jeng MJ. Factors associated with postoperative respiratory conditions and critical outcomes on pediatric liver transplantation: A single-center experience. J Chin Med Assoc 2022; 85:369-374. [PMID: 35019867 DOI: 10.1097/jcma.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is an established therapeutic option for pediatric end-stage liver disease (PELD). The postoperative respiratory conditions of OLT recipients may be associated with subsequent clinical outcomes including length of stay (LOS) in the pediatric intensive care unit (PICU). This study aimed to characterize the postoperative respiratory conditions, associated factors, and outcomes after pediatric OLT. METHODS Clinical data of children receiving OLT from July 2014 to July 2020 were retrospectively collected. Postoperative respiratory conditions were defined as time to extubation, significant pleural effusion, and initial postoperative PaO2/FiO2 ratio. Logistic and multiple regressions were applied to analyze the associations among clinical factors, postoperative respiratory conditions, and clinical outcomes. RESULTS Twenty-two patients with median age of 1.4-year-old (range: 25 days to 12 years old) were analyzed. Mortality within 28 days was 4.5% and median LOS in the PICU was 18 days. Of 22 patients, 11 patients (50.0%) were extubated over 24 hours after surgery, and 8 patients (36.4%) required drainage for pleural effusions. Longer LOS in the PICU were noted in patients extubated over 24 hours (p = 0.008), complicated with significant pleural effusions (p = 0.02) after surgery, and having low initial postoperative PaO2/FiO2 (<300 mmHg) (p = 0.001). Among clinical factors, massive intraoperative blood transfusion (>40 mL/kg) was significantly associated with prolonged intubations, significant pleural effusions, low initial postoperative PaO2/FiO2, and prolonged LOS in the PICU (>14 days). The initial postoperative PaO2/FiO2 significantly depended on age, disease severity (PELD score), and whether the patient received massive intraoperative blood transfusion. CONCLUSION Pediatric patients of OLT with poor postoperative respiratory conditions including low initial PaO2/FiO2 ratio, extubation over 24 hours or significant pleural effusions have longer LOS in the PICU, and the requirement of massive intraoperative transfusion was a risk factor for both poor postoperative respiratory conditions and prolonged LOS in the PICU.
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Affiliation(s)
- Jeng-Hung Wu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chin-Su Liu
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-Lin Tsai
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Ting Su
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsuan Tang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Ting Yeh
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Yu Chen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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7
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Mian MUM, Kennedy C, Fogarty T, Naeem B, Lam F, Coss-Bu J, Arikan AA, Nguyen T, Bashir D, Virk M, Harpavat S, Raynor T, Rana AA, Goss J, Leung D, Desai MS. The use of tracheostomy to support critically ill children receiving orthotopic liver transplantation: a single-center experience. Pediatr Transplant 2022; 26:e14140. [PMID: 34523781 DOI: 10.1111/petr.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/07/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children with end-stage liver disease and multi-organ failure, previously considered as poor surgical candidates, can now benefit from liver transplantation (LT). They often need prolonged mechanical ventilation (MV) post-LT and may need tracheostomy to advance care. Data on tracheostomy after pediatric LT are lacking. METHOD Retrospective chart review of children who required tracheostomy in the peri-LT period in a large, freestanding quaternary children's hospital from 2014 to 2019. RESULTS Out of 205 total orthotopic LTs performed in 200 children, 18 (9%) required tracheostomy in the peri-transplant period: 4 (2%) pre-LT and 14 (7%) post-LT. Among those 14 needing tracheostomy post-LT, median age was 9 months [IQR = 7, 14] at LT and 10 months [9, 17] at tracheostomy. Nine (64%) were infants and 12 (85%) were cirrhotic at the time of LT. Seven (50%) were intubated before LT. Median MV days prior to LT was 23 [7, 36]. Eight (57%) patients received perioperative continuous renal replacement therapy (CRRT). The median MV days from LT to tracheostomy was 46 [33, 56]; total MV days from initial intubation to tracheostomy was 57 [37, 66]. Four (28%) children died, of which 3 (21%) died within 1 year of transplant. Total ICU and hospital length of stay were 92 days [I72, 126] and 177 days [115, 212] respectively. Among survivors, 3/10 (30%) required MV at home and 8/10 (80%) were successfully decannulated at 400 median days [283, 584]. CONCLUSION Tracheostomy though rare after LT remains a feasible option to support and rehabilitate critically ill children who need prolonged MV in the peri-LT period.
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Affiliation(s)
- Muhammad Umair M Mian
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Curtis Kennedy
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Thomas Fogarty
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Buria Naeem
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fong Lam
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jorge Coss-Bu
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ayse A Arikan
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Trung Nguyen
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dalia Bashir
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Manpreet Virk
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sanjiv Harpavat
- Department of Pediatrics, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Tiffany Raynor
- Department of Surgery, Division of Pediatric Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Abbas A Rana
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA
| | - John Goss
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Leung
- Department of Pediatrics, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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8
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Hosokawa T, Tanami Y, Ihara Y, Mizuta K, Oguma E. Spontaneous recovery from diaphragmatic paralysis after liver transplantation. Pediatr Int 2022; 64:e15266. [PMID: 36178083 DOI: 10.1111/ped.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiyuki Ihara
- Department of Transplant Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Koichi Mizuta
- Department of Transplant Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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9
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Extracorporeal Membrane Oxygenation in Pediatric Liver Transplantation: A Multicenter Linked Database Analysis and Systematic Review of the Literature. Transplantation 2021; 105:1539-1547. [PMID: 32804800 DOI: 10.1097/tp.0000000000003414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) can be used to maintain oxygen delivery and provide hemodynamic support in case of circulatory and respiratory failure. Although the role of ECMO has emerged in the setting of adult liver transplantation (LT), data in children are limited. We aimed to describe the characteristics and outcomes of children receiving ECMO support at the time of or following LT. METHODS All pediatric LT recipients (≤20 y) requiring ECMO support peri-/post-LT were identified from a linked Pediatric Health Information System/Scientific Registry of Transplant Recipients dataset (2002-2018). The Kaplan-Meier method and Cox regression analysis were used to assess post-ECMO survival. A systematic literature review was conducted in accordance with the PRISMA statement. RESULTS Thirty-four children required ECMO peri-/post-LT. The median time from LT to ECMO was 5 d (interquartile range, 0.0-12.3), and the median ECMO duration was 1 d (interquartile range, 1.0-6.3). Children started on ECMO within 1 d of LT exhibited superior survival compared with those started on ECMO later (P = 0.03). When adjusting for recipient weight, increasing time from LT to ECMO initiation was associated with increased risk of mortality (hazard ratio, 1.03; 95% confidence interval, 1.00-1.06; P = 0.049). Overall, 55.9% (n = 19 of 34) of the patients survived. Twenty-two children receiving ECMO in the peri-/post-LT period were systematically reviewed, and 15 of them survived (68.2%). CONCLUSIONS With an encouraging >55% patient survival at 6 mo, ECMO should be considered as a viable option in pediatric LT recipients with potentially reversible severe respiratory or cardiovascular failure refractory to conventional treatment.
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10
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Pattnaik B, Sinha PK, Sadashiv NP, Mohapatra N, Pamecha V. Diaphragmatic Hernia after Pediatric Living Donor Liver Transplantation: An Indian Experience with Review of Literature. J Indian Assoc Pediatr Surg 2021; 26:246-249. [PMID: 34385768 PMCID: PMC8323575 DOI: 10.4103/jiaps.jiaps_134_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/13/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022] Open
Abstract
Aim: Although intestinal obstruction following living donor liver transplantation (LDLT) is relatively common, diaphragmatic hernia (DH) as the attributing cause is rarely reported. The study aimed to find out the incidence, clinical presentation, and management of DH after liver transplant in pediatric patients. Materials and Methods: A retrospective review of all cases of pediatric liver transplants was performed. Case sheets, operation records, and investigations including radiology were studied. Results: Out of 79 cases of pediatric liver transplants, two cases of posttransplant DH were identified. The first case is a 2-year-old male child who was transplanted for progressive familial intrahepatic cholestasis, and the second one is a 4-year-old boy who underwent LDLT for hepatitis A-induced acute liver failure. The first child presented abdominal symptoms and the second one with pulmonary symptoms. The DHs were diagnosed at 132 and 70 days, respectively, posttransplant by chest radiographs and computed tomography scan. The defects were located at the posteromedial aspect of the diaphragm in both the cases and were closed by primary closure with mesh reinforcement. Both the children are doing well with no recurrence. Conclusion: High index of clinical suspicion is mandated in pediatric patients after liver transplant and once the diagnosis is confirmed, urgent surgical exploration is mandatory.
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Affiliation(s)
- Bramha Pattnaik
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Piyush Kumar Sinha
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nilesh Patil Sadashiv
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nihar Mohapatra
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
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11
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Meng XY, Guo XG, Wang HQ, Pan ZY, Lu YG, Yu WF. Baseline neutrophil-lymphocyte ratio is associated with survival for infant living donor liver transplantation for biliary atresia. Pediatr Transplant 2021; 25:e13933. [PMID: 33270958 DOI: 10.1111/petr.13933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022]
Abstract
Living donor liver transplantation (LDLT) in infants for congenital biliary atresia (BA) poses various challenges nowadays. We aim to investigate independent preoperative risk factors for LDLT in infants. We retrospectively analyzed medical records of infant patients who underwent LDLT surgery for BA from 1 July 2014 to 31 December 2016. Cox regression was used to explore risk factors. The Kaplan-Meier method was used to calculate the recipient and graft survival, and subgroup analysis was then applied according to the risk factors. Independent t test or Mann-Whitney U test was applied for comparison of certain factors between survival patients and death. A total of 345 infant LDLT for BA were included in the analysis. In the multivariate Cox-regression model, 3 factors were determined as independent risk factors for recipient and graft survival, there were neutrophil-lymphocyte ratio (NLR), pediatric end-stage liver disease (PELD), and recipient age. The HR (95% CI) of baseline NLR for recipient and graft survival were 1.25 (1.12-1.38) and 1.25 (1.13-1.39), with all P < .0001. Kaplan-Meier curves for NLR using different cut-offs (1.5; 1, 2) suggested that higher baseline NLR was significantly associated with recipient and graft survival. The subgroup analysis indicated that for infants with elevated NLR, the recipient survival was significantly lower when their age >6 months or PELD >20. Our results indicate that infants with higher baseline NLR value may have lower survival rate 3 years after transplantation. Further investigations about broaden the application of pre- and post-transplant NLR to guide nutrition intervention and immunosuppression therapy are necessary.
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Affiliation(s)
- Xiao-Yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China.,Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Gang Guo
- Department of Surgery, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Hong-Qian Wang
- Department of Anesthesiology, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Ying Pan
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu-Gang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei-Feng Yu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Thirapattaraphan C, Srina P, Boonthai A, Arpornsujaritkun N, Sakulchairungrueng B, Apinyachon W, Treepongkaruna S. <p>Risk Factors of Pleural Effusion Following Pediatric Liver Transplantation and the Perioperative Outcomes</p>. TRANSPLANT RESEARCH AND RISK MANAGEMENT 2020. [DOI: 10.2147/trrm.s276511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Ruchonnet-Metrailler I, Blanchon S, Luthold S, Wildhaber BE, Rimensberger PC, Barazzone-Argiroffo C, Mc Lin VA. Pulmonary complications after liver transplantation in children: risk factors and impact on early post-operative morbidity. Pediatr Transplant 2018; 22:e13243. [PMID: 30019517 DOI: 10.1111/petr.13243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/15/2022]
Abstract
Liver transplantation (LT) is associated with high post-operative morbidity, despite excellent survival rates. With this retrospective study, we report the incidence of early and late pulmonary complications (PC) after LT, identify modifiable risk factors for PC and analyzed the role of PC in post-operative ventilation duration and hospital length of stay. In a series of 79 children (0-16 years) with LT over a 12 years period, early (<3 months post-LT) and/or late (>3 months post-LT) PC occurred in 68 patients (86%). Sixty-four percent (64%) developed early major complications such as pulmonary edema, atelectasis, or pleural effusion. Atelectasis requiring an intervention (P ≤ .02), pulmonary edema (P ≤ .02), or elevated PELD/MELD scores (P = .05) were associated with an increase in total ventilation duration and length of stay in the ICU. Risk factors for early PC included preoperative hypoxemia (P = .005), low serum albumin at LT admission (P = .003), or early rejection (P = .002). About 20% of patients experienced late PC of which 81% were infections. Risk factor assessment prior to LT may ultimately help reduce early PC thereby possibly minimizing post-operative morbidity and ICU length of stay.
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Affiliation(s)
| | - Sylvain Blanchon
- Pediatric Pulmonary and Allergy, Division, Children Hospital, University Hospitals Toulouse, Toulouse, France
| | - Samuel Luthold
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- Division of Pediatric Surgery, University Hospitals Geneva, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland
| | - Peter C Rimensberger
- Division of Neonatology and Pediatric Intensive Care, University Hospitals Geneva, Geneva, Switzerland
| | | | - Valérie A Mc Lin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Geneva, Switzerland
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14
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Abe M, Ide K, Nishimura N, Nakagawa S, Fukuda A, Sakamoto S, Kasahara M. Successful venoarterial extracorporeal membrane oxygenation for postoperative septic shock in a child with liver transplantation: A case report. Pediatr Transplant 2017; 21. [PMID: 28901029 DOI: 10.1111/petr.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 11/29/2022]
Abstract
Refractory septic shock after LT is a life-threatening complication. VA ECMO is used to treat refractory cardiorespiratory failure. We present herein the case of a 5-year-old girl with post-Kasai biliary atresia, who underwent a living donor LT and suffered refractory septic shock. VA ECMO was indicated due to progressive cardiac deterioration. After full recovery of her EF, she has been steadily improving and has shown good liver function and no neurological sequelae. This is the first report of successful VA ECMO in a post- LT patient with refractory septic shock.
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Affiliation(s)
- Michiko Abe
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nao Nishimura
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Nakagawa
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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15
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Khan HH, Schroeder L, Fitzpatrick MS, Kaufman SS, Yazigi NA, Yurasek GK, Steinhorn DM, Fishbein TM, Khan KM. Successful venoarterial extracorporeal membrane oxygenation for prolonged hepatopulmonary syndrome following pediatric liver transplantation: A case report and review of the literature. Pediatr Transplant 2017; 21. [PMID: 28833992 DOI: 10.1111/petr.13036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 01/16/2023]
Abstract
HPS is a major complicating feature of end-stage liver disease. Diagnosis is clinical, and LT is the only definitive treatment. While the general impression is that HPS improves quickly after transplantation, it may not always be the case. We describe the smallest reported child with HPS prior to LT and requiring prolonged venoarterial extracorporeal membrane oxygenation after LT; especially as it is a rare occurrence, physician managing such cases should be aware of the circumstances under which HPS may require specific treatment.
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Affiliation(s)
- Hamza Hassan Khan
- Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Laura Schroeder
- Critical Care Medicine, Childrens National Medical Center, Washington, DC, USA
| | - Megha S Fitzpatrick
- Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Stuart S Kaufman
- Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Nada A Yazigi
- Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Gregory K Yurasek
- Critical Care Medicine, Childrens National Medical Center, Washington, DC, USA
| | - David M Steinhorn
- Critical Care Medicine, Childrens National Medical Center, Washington, DC, USA
| | - Thomas M Fishbein
- Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Khalid M Khan
- Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
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16
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Jean S, Chardot C, Oualha M, Capito C, Bustarret O, Pouard P, Renolleau S, Lacaille F, Dupic L. Extracorporeal Membrane Oxygenation Can Save Lives in Children With Heart or Lung Failure After Liver Transplantation. Artif Organs 2017; 41:862-865. [DOI: 10.1111/aor.12975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/20/2017] [Accepted: 04/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Sandrine Jean
- Pediatric Intensive Care Unit; Hôpital Armand-Trousseau; Paris France
| | - Christophe Chardot
- Department of Surgery; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Carmen Capito
- Department of Surgery; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Olivier Bustarret
- Pediatric Intensive Care Unit; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Philippe Pouard
- Cardiac Surgery Intensive Care; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Sylvain Renolleau
- Pediatric Intensive Care Unit; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Florence Lacaille
- Department of Gastroenterology, Hepatology and Nutrition; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
| | - Laurent Dupic
- Pediatric Intensive Care Unit; Hôpital Universitaire Necker-Enfants Malades, Paris, Île-de-France; France
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17
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Olmscheid J, Molero H, Gershan W, Demirel N. Bilateral diaphragmatic paresis following pediatric liver transplantation. SAGE Open Med Case Rep 2017; 5:2050313X17719214. [PMID: 28781878 PMCID: PMC5521332 DOI: 10.1177/2050313x17719214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/02/2017] [Indexed: 12/04/2022] Open
Abstract
Background: Although diaphragm paresis or paralysis is fairly common following cardiac procedures; it is a less common complication following liver transplantation. Unilateral diaphragm paresis, usually right sided, has been described following liver transplantation in adults and has been rarely described in children. Purpose: Diaphragmatic injury following LT is often unrecognized and is typically unilateral, involving the right hemidiaphragm. Bilateral diaphragm dysfunction following liver transplantation in children is a rare complication. Methods: This is a case report of bilateral diaphragm paresis in a young child following a repeat liver transplantation. Conclusion: Bilateral diaphragm paresis following liver transplantation in children is rare and spontaneous resolution is possible. A conservative approach with noninvasive ventilation as a first line treatment to allow the diaphragm to regain function should be considered.
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Affiliation(s)
- Jillian Olmscheid
- Midwestern University, Glendale, AZ, USA.,Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Helena Molero
- Division of Pediatric Pulmonology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - William Gershan
- Division of Pediatric Pulmonology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Nadir Demirel
- Division of Pediatric Pulmonology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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18
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Miraglia R, Maruzzelli L, Piazza M, Gallo G, D'Amico M, Spada M, Vitulo P, Luca A. Real-time ultrasound-guided placement of a pigtail catheter in supine position for draining pleural effusion in pediatric patients who have undergone liver transplantation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:284-289. [PMID: 26332031 DOI: 10.1002/jcu.22294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Ultrasound (US) guidance is currently used for placement of wire-guided thoracic drains, and its use is associated with a decreased risk of complications. However, most studies conducted to date in this field have been performed on adult patients. The aim of this study was to report the technical success and complication rates observed during real-time US-guided placement of a thoracic pigtail catheter in pediatric liver-transplant recipients with symptomatic pleural effusion. METHODS This was a single-center retrospective review of the clinical records and images from pediatric liver-transplant patients with symptomatic pleural effusion who had undergone real-time US-guided pleural-space puncture followed by placement (via the Seldinger technique) of a pigtail catheter for drainage, between May 2006 and June 2014. RESULTS We identified 25 patients who had undergone 41 pigtail catheter-placement procedures during the study period. The patients' mean age (± SD) was 4.2 ± 3.9 years (range, 2 months to 16 years), and their mean weight was 14.2 ± 7.2 kg (range, 4.5-33 kg). Seventeen procedures had been performed in the intensive care unit, and 8, in patients undergoing mechanical ventilation. Twelve of the 41 procedures had been performed in patients with altered hemostasis (ie, platelet count < 50 × 10(3) /μl and/or international normalized ratio > 1.5). The size of the pigtail catheters ranged from 5 F to 8.5 F. The technical success rate was 100%, with no major complications such as pneumothorax or hemothorax. Accidental dislocation of the catheter occurred in four patients (9%) over 3-10 days after the first procedure. CONCLUSIONS In our experience, real-time US-guided pleural-space puncture, performed at bedside, with the patient in the supine position, followed by placement of a pigtail catheter for drainage of effusion, is safe to use and has a high rate of technical success in pediatric patients. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:284-289, 2016.
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Affiliation(s)
- Roberto Miraglia
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Luigi Maruzzelli
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Marcello Piazza
- Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Giuseppe Gallo
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Mario D'Amico
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Marco Spada
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Patrizio Vitulo
- Pneumology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Angelo Luca
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy
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19
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Ulubay G, Kirnap M, Er Dedekarginoglu B, Kupeli E, Oner Eyuboglu F, Haberal M. Awareness of Respiratory Failure Can Predict Early Postoperative Pulmonary Complications in Liver Transplant Recipients. EXP CLIN TRANSPLANT 2015; 13 Suppl 3:110-4. [PMID: 26640928 DOI: 10.6002/ect.tdtd2015.p64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients. MATERIALS AND METHODS Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure. RESULTS Our study included 204 (148 men and 56 women; mean age 43.0.4 ± 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit. CONCLUSIONS Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.
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Affiliation(s)
- Gaye Ulubay
- From the Department of Pulmonary Diseases, Baskent University, Ankara, Turkey
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20
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Aydin C, Otan E, Akbulut S, Karakas S, Kayaalp C, Karagul S, Colak C, Gonultas F, Yilmaz S. Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality. Transplant Proc 2015; 47:1488-94. [PMID: 26093749 DOI: 10.1016/j.transproceed.2015.04.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. METHOD Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson's χ(2) test, Fisher's exact test, and Yate's corrected χ(2) test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index. RESULTS The 153 patients with pulmonary complication were divided into 2 groups: mortality (n = 53) and survival (n = 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P = .035), duration of mechanical ventilation (P > .001), pneumonia (P = .01), and endotracheal culture results (P = .001). In the multivariate analysis, hemoglobin (P = .03, odds ratio [OR]: 1.239), MELD score (P = .027, OR: 1.064), duration of mechanical ventilation (P = .003, OR: 1.091), and age (P = .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%). CONCLUSION Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.
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Affiliation(s)
- C Aydin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - E Otan
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - S Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - S Karakas
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - C Kayaalp
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - S Karagul
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - C Colak
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - F Gonultas
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - S Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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21
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Sonavane S, Guleria S, Crowe DR, Steenwyk B, Singh S. Progressive lung calcification after orthotopic heart transplant. Pediatr Radiol 2015; 45:124-8. [PMID: 24907924 DOI: 10.1007/s00247-014-3023-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/09/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022]
Abstract
Focal, asymmetrical pulmonary airspace opacities in post-transplant setting are commonly from infection, hemorrhage, edema or infarction. Rarely, stable or mildly progressive dense pulmonary opacities are due to pulmonary calcifications. In the majority of cases, these are asymptomatic and warrant no further intervention.
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Affiliation(s)
- Sushilkumar Sonavane
- Cardiopulmonary Section, Department of Radiology, University of Alabama at Birmingham, 619 19th St. S JTN 370, Birmingham, AL, 35294, USA,
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22
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Shigeta T, Sakamoto S, Kanazawa H, Fukuda A, Kakiuchi T, Karaki C, Uchida H, Matsuno N, Tanaka H, Kasahara M. Diaphragmatic hernia in infants following living donor liver transplantation: report of three cases and a review of the literature. Pediatr Transplant 2012; 16:496-500. [PMID: 22672688 DOI: 10.1111/j.1399-3046.2012.01722.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DH is a rare complication following LT. This report presents three cases of right-sided DH after LT using a left-sided graft. All of the patients were younger than one yr of age, and they were critically ill owing to their original disease, characterized by biliary atresia, progressive familiar intrahepatic cholestasis, and acute liver failure. DH occurred with sudden onset within three months after LT. All of the cases were promptly diagnosed and treated. A literature review of 24 cases of DH identified four factors associated with DH: left-sided graft, right-sided DH, relatively delayed onset of DH, and age-specific chief complaint. DH following LT should be considered as a potential surgical complication when a left-sided graft is used, especially in small infants with coagulopathy and malnutrition.
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Affiliation(s)
- Takanobu Shigeta
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
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23
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Moon SB, Jung SM, Kwon CH, Kim SJ, Joh JW, Seo JM, Lee SK. Posteromedial diaphragmatic hernia following pediatric liver transplantation. Pediatr Transplant 2012; 16:E106-9. [PMID: 21235708 DOI: 10.1111/j.1399-3046.2010.01462.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Diaphragmatic hernia is a rare complication following pediatric LT. Here, four children who developed right-sided posteromedial diaphragmatic hernias after LT are reported. The primary disease was biliary atresia in two patients, hemangioendothelioma in one, and angiosarcoma in one patient. All of the patients underwent living-donor LT using a left lateral graft. The patients presented with abdominal and/or pulmonary signs and symptoms. The diaphragmatic hernias were diagnosed at 28 days to seven months post-transplant by standard radiographs or chest CT. The defects were located at the posteromedial aspect of the diaphragm and were closed by primary closure. After diaphragm repair, the post-operative course was unremarkable and there were no recurrences. Thermal or mechanical injuries to the bare area, especially in cases of excessive adhesion between the liver and diaphragm after Kasai operation, were the possible causes of the posteromedial diaphragmatic hernia after pediatric LT.
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Affiliation(s)
- Suk-Bae Moon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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Zhong L, Men TY, Li H, Peng ZH, Gu Y, Ding X, Xing TH, Fan JW. Multidrug-resistant gram-negative bacterial infections after liver transplantation - spectrum and risk factors. J Infect 2011; 64:299-310. [PMID: 22198738 DOI: 10.1016/j.jinf.2011.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/09/2011] [Accepted: 12/10/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Gram-negative bacilli infections, especially multidrug-resistant gram-negative bacilli infections, are the leading cause of high mortality after liver transplantation. This study sought to investigate the type of infection, infection rate, pathogenic spectrum, antibiotic-resistance profile, risk factors, and epidemiology of multidrug-resistant gram-negative bacterial infection. METHODS A retrospective cohort study was conducted and data of 217 liver transplant patients receiving cadaveric livers between January 2007 and April 2010 were analyzed. Antibiotic susceptibility was determined by minimum inhibitory concentration test. Extended-spectrum and metallo-β-lactamase assays were used to analyze β-lactamase-produced isolates, and repetitive-sequence polymerase chain reaction was used to differentiate bacterium subspecies. RESULTS Sixty-seven isolates of multidrug-resistant gram-negative bacteria were isolated from 66 infected liver transplant patients. Stenotrophomonas maltophilia (100%, 8/8), Klebsiella pneumoniae (61.5%, 8/13), Enterobacter cloacae (75%, 3/4) and Escherichia coli (81.3%, 13/16) were the most common extended-spectrum β-lactamase-producing bacilli. Metallo-β-lactamase expressing isolates were identified as S. maltophilia (100%, 8/8), Pseudomonas aeruginosa (83.3%, 5/6), Acinetobacter baumannii (95%, 19/20). Significant independent risk factors for multidrug-resistant gram-negative infection were extended use of pre-transplant broad-spectrum antibiotics (OR 9.027, P=0.001) and prolonged (≧72h) endotracheal intubation (OR 3.537, P=0.033). CONCLUSIONS To reduce the risk of acquiring MDR gram-negative bacillus infections after liver transplant, control measures are required to limit the use of prophylactic antibiotic in preventing infection during liver transplant and to shorten endotracheal intubation time.
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Affiliation(s)
- Lin Zhong
- Department of General Surgery, Shanghai First Peoples Hospital, Medical School of Shanghai Jiaotong University, 85 Wu Jing Road, 200080 Shanghai, People's Republic of China.
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Kazimi M, Ibis C, Alper I, Ulas M, Baran M, Arikan C, Aydogdu S, Ulukaya S, Zeytunlu M, Kilic M. Right-sided diaphragmatic hernia after orthotopic liver transplantation: report of two cases. Pediatr Transplant 2010; 14:e62-4. [PMID: 19344340 DOI: 10.1111/j.1399-3046.2009.01168.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diaphragmatic hernia after OLT is a rare surgical complication. We here report successful diagnosis and treatment of two cases with right-sided diaphragmatic hernia developed after OLT both utilizing left-sided allografts. Combination of factors related to the surgical techniques and patient characteristics might explain the pathophysiology behind the diaphragmatic hernias following liver transplantation. Respiratory as well as non-specific gastrointestinal symptoms may be hints for an overlooked diaphragmatic hernia after liver transplantation. Diaphragmatic hernia should be added to the list of potential complications of liver transplantation for prompt diagnosis and appropriate treatment.
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Affiliation(s)
- M Kazimi
- Ege University Organ Transplantation Center, Izmir, Turkey
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Fleming GM, Cornell TT, Welling TH, Magee JC, Annich GM. Hepatopulmonary syndrome: use of extracorporeal life support for life-threatening hypoxia following liver transplantation. Liver Transpl 2008; 14:966-70. [PMID: 18581508 PMCID: PMC4414403 DOI: 10.1002/lt.21477] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hepatopulmonary syndrome is an uncommon complication of nonacute liver failure, and in rare cases, hypoxia may be the presenting sign of liver dysfunction. The condition, once thought to be a contraindication, is improved in most cases by transplantation. There is a significant risk of postoperative, hypoxia-related morbidity and mortality in patients with hepatopulmonary syndrome. We present a case of life-threatening hypoxia following liver transplantation for liver failure and associated hepatopulmonary syndrome, with successful management using extracorporeal membrane oxygenation.
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Okajima H, Hayashida S, Iwasaki H, Suda H, Takeichi T, Ueno M, Asonuma K, Inomata Y. Bowel obstruction due to diaphragmatic hernia in an elder child after pediatric liver transplantation. Pediatr Transplant 2007; 11:324-6. [PMID: 17430491 DOI: 10.1111/j.1399-3046.2006.00658.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 10-yr-old boy with end-stage liver cirrhosis due to Wilson's disease received a living donor liver transplantation (LDLT) at our institution. The donor was his father and the graft was a left lateral segment. The liver transplantation procedure and the postoperative course were uneventful. Two months after the procedure, he developed a first episode of bowel obstruction that was treated with conservative therapy. During a second episode of bowel obstruction, he also presented respiratory distress. A plain chest X-ray revealed the presence of small intestine loops in the right thoracic cavity and bowel obstruction due to diaphragmatic hernia was diagnosed. Repair of the diaphragmatic hernia was performed and the patient has been doing well after the surgery. Diaphragmatic hernia after LDLT is rare but should be recognized as a possible complication when a left lobe or a left lateral segment graft is used.
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Affiliation(s)
- Hideaki Okajima
- Department of Transplantation/Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
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Weaver OO, Stazzone MM, Bhalla S. Progressive pulmonary calcification in a child after orthotopic liver transplantation. Pediatr Radiol 2006; 36:546-51. [PMID: 16568296 DOI: 10.1007/s00247-006-0132-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 01/31/2006] [Accepted: 02/06/2006] [Indexed: 10/24/2022]
Abstract
We present a case of progressive pulmonary calcification associated with prolonged respiratory insufficiency in a 2-year-old boy with a history of orthotopic liver transplantation. This case demonstrates the potentially progressive nature of pulmonary calcification and that it can present with respiratory insufficiency at a later period after transplantation than previously thought. We describe radiological findings and discuss established as well as plausible pathological mechanisms contributing to the development of calcifications in these patients.
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Affiliation(s)
- Olena O Weaver
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
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O'Meara ME, Whiteley SM, Sellors JM, Luntley JM, Davison S, McClean P, Rajwal S, Prasad R, Stringer MD. Immediate Extubation of Children Following Liver Transplantation Is Safe and May Be Beneficial. Transplantation 2005; 80:959-63. [PMID: 16249745 DOI: 10.1097/01.tp.0000174132.18652.81] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immediate tracheal extubation of selected adult patients after orthotopic liver transplant (OLT) is common practice. We hypothesized that selected children may be safely extubated immediately after OLT and avoid potentially deleterious effects of artificial ventilation and sedation. METHODS After June 2002, we chose immediate extubation unless a specific contraindication was identified. Charts of all children undergoing OLT between June 2002 and February 2005 were reviewed to audit safety and outcome of this approach. Comparative data were obtained for children undergoing first elective OLT at other UK centers. RESULTS Forty-six cadaveric liver transplants were performed in 40 patients: 26 of 34 (76%) elective transplants and 4 of 12 (33%) urgent transplants were extubated immediately after surgery. Eight of 14 (57%) children weighing less than 10 kg were successfully extubated. One child required reintubation after developing transfusion-related acute lung injury. There were no other events compromising patient or graft. Small recipient size, split/reduced grafts, preexisting respiratory disease, retransplantation, and acute liver failure did not individually preclude successful immediate extubation. After elective OLT, the mean duration of intensive care stay was significantly shorter in the extubated group than in those who were ventilated (2.5 vs. 6.1 days, P<0.01). All children receiving a liver transplant at other UK centers in 2003 were ventilated postoperatively. However, the median duration of intensive care stay (2 days) was the same as in our series. CONCLUSIONS Immediate extubation of selected children after OLT is safe. It may enhance patient recovery, benefit graft physiology, and reduce intensive care requirement.
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Affiliation(s)
- Moira E O'Meara
- Department of Anesthesia, St. James's University Hospital, Leeds, United Kingdom.
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McCabe AJ, Orr JD, Sharif K, De Ville de Goyet J. Right-sided diaphragmatic hernia in infants after liver transplantation. J Pediatr Surg 2005; 40:1181-4. [PMID: 16034767 DOI: 10.1016/j.jpedsurg.2005.03.063] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Liver transplantation is just as successful in infants as in older children, but more challenging. This relates to the low weight of the recipients and to their rapidly deteriorating clinical condition (malnutrition and end-stage liver disease) ( J Pediatr 1990;117:205-210; BMJ 1993;307:825-828; Ann Surg 1996;223:658-664; Transplantation 1997;64:242-248; J Pediatr Surg 1998;33:20-23). In addition, higher rates of diaphragmatic complications have been shown to significantly correlate with a younger age ( Transplantation 2002;73:228-232; Transpl Int 1998;11:281-283; Pediatr Transplant 2000;4:39-44), but diaphragmatic hernia has never been reported as a complication of liver transplantation. In this report, 2 patients who developed diaphragmatic hernia after liver transplantation are presented. The possible role of several contributing factors resulting in diaphragmatic hernia is discussed. These factors include (1) diaphragm thinness related to low weight and malnutrition, (2) direct trauma at operation (dissection and diathermy), (3) increased abdominal pressure after transplantation caused by the use of a slightly oversized liver graft, and (4) the medial positioning of the partial liver graft in the abdomen.
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Affiliation(s)
- Amanda J McCabe
- Department of Paediatric Surgery, Royal Hospital for Sick Children, EH9 1LF Edinburgh, UK
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Pirat A, Ozgur S, Torgay A, Candan S, Zeyneloğlu P, Arslan G. Risk factors for postoperative respiratory complications in adult liver transplant recipients. Transplant Proc 2004; 36:218-20. [PMID: 15013351 DOI: 10.1016/j.transproceed.2003.11.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To determine the types and the incidence of as well as risk factors for early postoperative (<30 days) respiratory complications in adult liver transplant (LT) recipients, we reviewed The data of 44 consecutive adult LT recipients who received their grafts from January 1995 through December 2002. The data included demographic features; primary diagnosis; number of intraoperative transfusions; preoperative and postoperative laboratory values; intraoperative and postoperative characteristics; and early postoperative (<30 days) mortality. Pulmonary atelectasis, pleural effusion, pneumonia, respiratory failure, and pulmonary edema were the respiratory complications investigated. Twenty-six patients (59.1%) developed at least one respiratory complication during the early postoperative period. The most frequent complication was pleural effusion (n = 18, 40.9%), followed by atelectasis (n = 13, 29.5%), pneumonia (n = 10, 22.7%), acute respiratory failure (n = 5, 11.4%), pulmonary edema (n = 3, 6.8%), and pneumothorax (n = 2, 4.5%). Compared to the patients who did not develop these problems, the affected cohort was significantly older (27 +/- 12 years vs 36 +/- 14 years, respectively; P =.039) and required more intraoperative transfusions (P =.005). Among the overall mortality rate of 15.9%, patients who developed pneumonia showed a significantly higher mortality (40.0% vs 8.8%, respectively; P =.037). Pleural effusion, atelectasis, and pneumonia are the main respriatory complications that occur in adult LT recipients. Patient age and intraoperative transfusion requirements are important predictors of early postoperative complications. Pneumonia is associated with a poor prognosis in this patient group.
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Affiliation(s)
- A Pirat
- Başkent University, Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey.
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Lin CC, Chuang FR, Wang CC, Chen YS, Chen CL, Liu YW, Cheng YF, Lee CH, Jawan B. Early postoperative complications in recipients of living donor liver transplantation. Transplant Proc 2004; 36:2338-41. [PMID: 15561242 DOI: 10.1016/j.transproceed.2004.07.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Complications are common in the early postoperative period after living donor liver transplantation (LDLT). The aims of this analysis were to describe and identify risk factors for early postoperative complications. METHODS Between June 1994 and June 2003, 140 consecutive LDLT patients were divided into 3 groups: group I was small infants <9 kg (n = 30); group II, pediatric patients (n = 63); and group III, adult patients (n = 47). The complications within 3 months after operation were analyzed. RESULTS The mortality rate was 1.4%. Surgical complications requiring relaparotomy occurred in 7.9% of patients. Intraoperative portal vein thrombosis requiring immediate thrombectomy, which occurred in 10 patients, was significantly more frequent in the small infant group (23.1% vs 3.2% vs 2.1%; P < .01). Acute hepatic artery thrombosis that occurred in 2 patients was remedied successfully using operative rearterilization. Hepatic outflow obstruction requiring radiological interventions developed in 5 subjects. Medical complications included the following: pulmonary (14.3%), renal (19.3%), bacteremia (10.7%), cytomegalovirus infection (9.3%), and drain-related infections (20.7%). The incidence of hospital-acquired renal insufficiency was significantly higher in adult patients (3.3% vs 14.3% vs 36.2%; P < .01). There was no significant difference in the incidence of acute cellular rejection between members of the 3 groups (10.0% vs 17.5% vs 17%; P = .63). CONCLUSIONS Sophisticated postoperative care with multiple disciplinary involvements may achieve a low early mortality rate in LDLT. Small infants weighing <9 kg may carry a greater risk of intraoperative portal vein thrombosis. Pulmonary complications and renal function impairments were the most troublesome in pediatric and adult recipients, respectively.
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Affiliation(s)
- C-C Lin
- Department of Surgery, Liver Transplant Program, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
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Wallot MA, Klepper J, Clapuyt P, Dirsch O, Malagó M, Reding R, Otte JB, Sokal EM. Repeated detection of gas in the portal vein after liver transplantation: A sign of EBV-associated post-transplant lymphoproliferation? Pediatr Transplant 2002; 6:332-6. [PMID: 12234275 DOI: 10.1034/j.1399-3046.2002.02001.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 1-yr-old child presented with intractable right sided pleural effusion and progressive clinical deterioration 3 weeks after liver transplantation for Alagille Syndrome. He had been treated successfully for severe acute rejection before. Ultrasound and Doppler mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal and intra-thoracic lymphoproliferation was detected, and EBV virus load and serology were suggestive of primary EBV infection. Liver biopsy revealed blast-like infiltrates of B-cells, considered diagnostic for post-transplant lymphoproliferative disease. The disease resolved upon reduction of immunosuppression. We suggest that the detection of portal vein gas in pediatric liver transplant recipients beyond the early post-operative period may be a sign of intra-abdominal post-transplant lymphoproliferative disease.
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Affiliation(s)
- Michael A Wallot
- Department of Pediatrics, Universitätsklinikum Essen, Hufelandstr.55, 45122 Essen, Germany.
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Abstract
Renal transplantation accounts for more than half of all solid organ transplants performed in the U.S., and the liver is the second most commonly transplanted solid organ. Although abdominal imaging procedures are commonplace in these patients, there has been relatively little attention paid to thoracic imaging applications. Preoperative imaging is crucial to aid in the exclusion of infectious or malignant disease. In the perioperative time period, thoracic imaging focuses both on standard intensive care unit care, including monitoring devices and their complications, and on the early infections that can occur. Postoperative management is divided into three time periods, and the principles governing the occurrence of infections and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney and liver transplantation patients are also discussed.
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Affiliation(s)
- Joel E Fishman
- Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital WW 279, 1611 N.W. 12th Avenue, Miami, FL 33136, USA.
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Manczur TI, Greenough A, Rafferty GF, Dimitriou G, Baker AJ, Mieli-Vergani G, Rela SM, Heaton N. Diaphragmatic dysfunction after pediatric orthotopic liver transplantation. Transplantation 2002; 73:228-32. [PMID: 11821735 DOI: 10.1097/00007890-200201270-00013] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric orthotopic liver transplantation (OLT) has a low mortality. Some children, however, have an adverse outcome defined as a prolonged ventilatory support requirement and protracted pediatric intensive care unit (PICU) stay. The aim of this study was to determine if that adverse outcome related to the child's condition pre-OLT and/or the development of a pleural effusion or diaphragmatic dysfunction. METHODS The study included 210 children with a median age at transplantation of 45.5 months (range 0.2-252 months). Fourteen had undergone retransplantation. The duration of ventilatory support (intermittent positive pressure ventilation [IPPV]) and PICU admission and development of a pleural effusion and/or diaphragmatic dysfunction were documented for each child. The patients were divided into three groups according to whether they had acute liver failure (ALF), chronic liver disease at home (CHOM), or chronic liver failure sufficiently ill to be in the hospital awaiting transplantation (CHOSP). RESULTS The 36 children with ALF were of similar age to the 138 CHOM and 36 CHOSP children but required longer IPPV (P<0.0001) and PICU stay (P<0.0001). Overall, 17 children developed diaphragmatic dysfunction and 138 pleural effusions; affected children required longer IPPV and PICU stay (P<0.01). Regression analysis demonstrated that diaphragmatic dysfunction, but not pleural effusion development, was associated with prolonged ventilation (P<0.01) and protracted PICU stay (P<0.05). Other risk factors were ALF (P<0.01), retransplantation (P<0.01), and young age (P<0.05). CONCLUSION Diaphragmatic dysfunction adversely influences PICU morbidity after OLT. Early assessment of diaphragmatic function, and if necessary aggressive management, might improve outcome.
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Affiliation(s)
- Terezia I Manczur
- Department of Child Health, King's College Hospital, London SE5 9RS, United Kingdom
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