Risk Factors of Pleural Effusion Following Pediatric Liver Transplantation and the Perioperative Outcomes

Background: Pediatric liver transplantation (LT) has been accepted as a definitive treatment for end-stage liver disease. Pleural effusion is a common pulmonary complication following LT in children. The objectives of the study were to identify prevalence of post-LT pleural effusion, risk factors, and the impact on patients' outcomes. Methods: A retrospective study was conducted in 107 pediatric patients who underwent LT at our center between March 2001 and June 2018. They were categorized into pleural effusion and non-pleural effusion groups. Preoperative and perioperative data, intraoperative findings, liver graft characteristics, and perioperative outcomes were compared between the two groups. Results: Post-LT pleural effusion occurred in 64 (59.8%) patients. There were more patients with PELD score >= 18 in the pleural effusion group (68.8 vs 48.8%, P=0.039). Other preoperative and perioperative data were not significantly different. The pleural effusion group had a higher rate of reoperation than non-pleural effusion group (55.6 vs 30.9%, P=0.013). Median oxygen dependence time, length of ICU and hospital stay were significantly longer in the pleural effusion group (18.5 vs 7.0, 10 vs 7 and 48 vs 34 days, respectively, P <0.05). However, mortality was not significantly different. Among the patients with pleural effusion, median time to extubation, oxygen dependence time, length of ICU and hospital stay were significantly longer in those who required therapeutic interventions than those without interventions (12 vs 3, 31 vs 10, 17 vs 8, and 60 vs 43 days, respectively, P <0.05). Conclusion: Pleural effusion following pediatric LT is common and its potential risk factor is PELD score at LT >= 18. Post-LT pleural effusion is associated with prolonged oxygen dependence time, ICU stay and hospital stay, particularly those who required therapeutic interventions.