Routine postoperative care of liver transplant recipients

Pediatric liver transplantation is a high-risk, resource-intensive procedure in which early postoperative management decisively influences graft survival and patient outcomes. The immediate posttransplant period is marked by profound physiological transitions, including reperfusion injury, hemodynamic instability, coagulation derangements, and resolution of complications related to end-stage liver disease. Effective care requires structured protocols, vigilant monitoring, and timely interventions within the pediatric intensive care unit (PICU). Key elements include seamless intraoperative to PICU handover, goal-directed hemodynamic stabilization, lactate-guided assessment of graft perfusion, judicious fluid stewardship, renal protection, and lung-protective ventilation strategies that support early extubation. Targeted hemostatic management using viscoelastic testing, particularly rotational thromboelastometry, balances bleeding risk against postreperfusion thrombosis, while prophylactic anticoagulation reduces hepatic artery thrombosis risk. High-frequency Doppler ultrasonography enables early detection of vascular complications, and standardized immunosuppression with therapeutic drug monitoring plus tailored infection prophylaxis is integral. A protocol-based approach is fundamental to preserving graft function and improving long-term outcomes.