Early Pulmonary Complications After Paediatric Liver Transplantation: A Single Center Experience.

Objective: This study aimed to evaluate early pulmonary complications (EPCs) and factors affecting mechanical ventilation duration in paediatric patients following liver transplantation (LT).

Methods: Between June 2014 and June 2024, 56 paediatric patients who underwent LT at our centre were retrospectively included. Pre- and post-transplant clinical features, nutritional status, surgical details, and respiratory outcomes were analysed. Patients were compared according to the presence or absence of EPCs.

Results: Among the 56 patients (53.6% male, median age 26 months [IQR: 11.25-120]), EPCs 9 in 71.4% of patients, with atelectasis being the most frequent (58.9%), followed by pleural effusion (37.5%) and pneumonia (33.9%). The median postoperative PICU stay was 10.5 days (IQR: 5.25-20.75), and 17.9% of patients died within 3 months, none due to acute pulmonary complications. Patients with EPCs had significantly longer PICU stays (13.5 [7-25] vs. 5.5 [3.5-11.8] days, p = 0.007), higher reintubation rates (40% vs. 6.3%, p = 0.022), and longer durations of invasive mechanical ventilation (IMV) (5.5 [1-14.5] vs. 2 [1-4.5] days, p = 0.044). Underweight status (p = 0.038), history of lower respiratory tract infection (LRTI) before LT (p = 0.047), and postoperative surgery within 1 month (p = 0.002) were associated with prolonged IMV. Use of noninvasive ventilation (NIV) post-LT was associated with a shorter IMV duration (p = 0.011).

Conclusions: Early pulmonary complications are common following paediatric LT and are associated with increased respiratory morbidity and longer PICU stays. Undernutrition, prior LRTI, and early postoperative surgery are risk factors for prolonged IMV. Early recognition and management strategies may improve respiratory outcomes in this population.