Initiating a paediatric living donor liver transplant program in a resource-challenged environment: outcomes and lessons learned.

Abstract

Purpose: Paediatric liver transplantation (PLT) is a life-saving yet complex procedure requiring coordinated multidisciplinary expertise. This study aimed to evaluate anaesthetic and surgical factors influencing outcomes in paediatric living donor liver transplantation at a newly established centre in Malaysia.

Methods: We conducted a retrospective cohort study of 21 paediatric patients who underwent living donor liver transplantation between August 2019 and January 2024 at our centre. Perioperative variables including surgical duration, intraoperative blood loss, transfusion volume, and postoperative mechanical ventilation were analysed. Associations with three-year survival were assessed.

Results: The median age of recipients was 33 months, with biliary atresia as the leading indication (66.7%). The median operative time was 10.9 h. Massive intraoperative bleeding occurred in 47.6% of patients, and 42.8% required massive transfusion. Median ventilator duration was 2 days, and the three-year survival rate was 70.6%. Intraoperative blood loss (p = 0.03) and prolonged ventilation (p = 0.01) were significantly associated with reduced survival. Higher PELD scores and operative duration > 600 minutes were also associated with prolonged ventilation and increased mortality.

Conclusions: Massive blood loss, prolonged operative duration, and delayed extubation significantly affect outcomes in PLT. Strengthening perioperative haemodynamic and ventilation strategies is crucial to improve survival in resource-limited transplant settings.