Acute complications following liver transplantation in children

Although survival outcomes of liver transplantation in children have improved substantially over the past decades, it remains associated with significant perioperative morbidity, particularly in the early posttransplant period. Early posttransplant complications are broadly categorized into vascular and nonvascular events. Vascular complications – including hepatic artery thrombosis, portal vein thrombosis, and hepatic venous outflow obstruction – can critically impact graft viability and patient survival. Routine Doppler surveillance and timely revascularization are key to improving outcomes. Nonvascular complications encompass gastrointestinal events such as bowel perforation, bleeding, intestinal obstruction, intra-abdominal hypertension, and biliary complications, which remain a major source of morbidity. Acute rejection, predominantly T-cell mediated, is common but generally responsive to immunosuppressive therapy when diagnosed early. Infectious complications, particularly in the 1 st month posttransplant, are driven by immunosuppression, surgical factors, and prolonged intensive care unit stay, with multidrug-resistant organisms posing significant challenges. Additional complications affecting respiratory, renal, neurological, and metabolic issues require vigilant monitoring and multidisciplinary management. This review aims to provide a concise overview of common immediate postliver transplant complications and management in children, relevant to pediatric critical care specialists.