Title: Respiratory complications following pediatric liver transplantation: frequency, risk factors, and clinical predictors of chronic morbidity
Source: Transplantation Proceedings 2026, April 18. [E-publication]
Date of publication: April 2026
Publication type: Retrospective analysis
Abstract: Objective: To investigate the incidence, characteristics, and risk factors of postoperative respiratory complications in pediatric liver transplant (LT) recipients, and to identify clinical predictors of chronic respiratory morbidity.
Methods: We retrospectively analyzed data from 42 pediatric patients who underwent LT between 2014 and 2020. Variables assessed included demographics, primary liver disease, pre-transplant comorbidities, perioperative factors, and postoperative respiratory complications (PTRCs). Complications were categorized as early or chronic (persisting >3 months). Statistical associations between complications and clinical features were evaluated.
Results: Postoperative respiratory complications occurred in 67% of patients, with pleural effusion (45%), pneumonia (33%), and postextubation respiratory failure (33%) being most common. Chronic respiratory complications were observed in 14% of patients and were significantly associated with prior abdominal surgery, prolonged pediatric intensive care unit stay, and postextubation respiratory failure. Pre-transplant pneumonia, ascites, portal hypertension, and recurrent abdominal surgery were identified as significant risk factors for PTRCs. Pulmonary hemorrhage was the only complication associated with mortality.
Conclusion: Respiratory complications are common in pediatric LT recipients and are strongly associated with pre-existing pulmonary and intra-abdominal conditions. Early recognition of at-risk patients may allow for improved perioperative strategies and long-term respiratory outcomes.
