Abstract
Aims & Objectives: Liver transplantation is an effective and definitive treatment for children with end-stage liver disease. In Almaty City pediatric liver transplantation is centered at the National Scientific Center of Surgery. The aim of this study is to highlight the perioperative patients’ problems that our multidisciplinary team faced in the pediatric liver transplantation program. Methods: We analyzed our experience of liver transplantation in 40 patients from 2016 till 2022 and studied the severity of the initial condition, the number of postoperative problems, and the length of stay of patients in the ICU and hospital. Results: 29 patients aged under 2 years (7.8±2.3 mo), weight 7.9±1.1 kg, PELD 23.6±6.2. Preoperatively 43.9% of children have tensed ascites, 75.6%–encephalopathy, 48.8%–infections, 12.2%–severe malnutrition, 65.9%–anemia. After surgery, patients presented next complications: gastrointestinal paresis–75%, exacerbation of chronic liver failure–62.5%, acute renal failure–42.5%, great and prolonged ascites loss–35%, circulatory failure–30%, SIRS–30%, acute encephalopathy–25%, intraabdominal hypertension–22.5%, gastrointestinal bleeding–17.5%, postoperative bleeding–22.5%, intestinal perforation–7.5%, stroke–7.5%. ICU stay was 28.1±28.0 days (6-139), in-hospital stay was 34.5±62.8 days (18-163). Postoperative mortality in children under 2 years is 48.3%. Most common complications are exacerbation of chronic liver failure, gastrointestinal paresis, intraabdominal hypertension, acute renal failure, and SIRS. Conclusions: In our opinion, the trigger for the development of complications is gastrointestinal paresis which causes intraabdominal hypertension, acute renal failure, SIRS, and exacerbation of chronic liver failure. Keywords: perioperative management, postoperative intensive care, liver transplantation