Title: Postoperative fluid balance and outcomes in pediatric living-donor liver transplant recipients: a retrospective cohort study
Source: Journal of Anesthesia 2025, May 24. [E–publication]
Date of publication: May 2025
Publication type: Retrospective cohort study
Abstract: 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.
