Respiratory complications following pediatric liver transplantation: frequency, risk factors, and clinical predictors of chronic morbidity

Abstract

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.