(902) Fluid Balance and Outcomes After Pediatric Living-Donor Liver Transplantation: A Retrospective Study

Introduction: Excessive fluid balance (FB) after adult liver transplantation (LT) is associated with adverse outcomes such as prolonged mechanical ventilation and acute kidney injury (AKI). Pediatric LT recipients, who are with high risk of postoperative thrombosis, traditionally receive positive FB management. However, there is little study to assess the impact of postoperative FB on outcomes in this cohort, and none focus specifically on living-donor (LD) LT. This study examined perioperative FB and outcomes including mechanical ventilation duration, the incidence of AKI and thrombosis, in pediatric LDLT.

Methods: This retrospective study at Kyoto University Hospital involved pediatric patients (≤18 years) who underwent LDLT from January 2010 to September 2023. FB was calculated as [(fluid intake (L) − fluid output (L)) / body weight (kg)] × 100 for 48 postoperative hours. Patients categorized into four groups according to their FB: < 5%, 5–10%, 10–15%, and ≥15%. Primary outcome was ventilator-free days (VFD) within 30 days. Secondary outcomes were AKI, reintubation, thrombosis, Intensive Care Unit (ICU) length of stay (LOS), and mortality.

Results: The study involved 208 patients. Median weight was 8.7 kg (interquartile range [IQR], 6.8–19.3). The FB group distribution as follows: < 5% (n=68, 32.7%), 5–10% (n=66, 31.7%), 10–15% (n=48, 23.1%), and ≥15% (n=26, 12.5%). Median (IQR) VFD were not significantly differed across FB groups: < 5% FB, 29.3 days (28.3–29.4); 5-10% FB, 29.3 days (27.6–29.4); 10-15% FB, 29.3 days (27.6–29.4); ≥15% FB, 27.4 days (23.5–29.4) (p=0.10). However, multivariable analysis revealed that FB ≥15% was significantly associated with shorter VFD compared to FB < 5% (β = -4.73, p=0.002). Additionally, FB ≥15% was independently associated with increased AKI (odds ratio [OR] = 6.06, p=0.005) compared with FB < 5%. Thrombosis occurred in 10 patients (4.8%) with no significant differences observed among FB groups (p=0.65). Other outcomes including reintubation, acute rejection, and ICU LOS did not differ significantly among FB groups.

Conclusions: Excessive postoperative FB in pediatric LDLT recipients was significantly associated with reduced VFD and increased AKI, while not demonstrating significant associations with other adverse events.