Risk factors and outcomes of prolonged mechanical ventilation following pediatric liver transplantation: a retrospective cohort study

Background Prolonged postoperative mechanical ventilation (PPMV) after pediatric liver transplantation is frequently associated with increased morbidity and mortality. Identifying the causes and associated risk factors will help improve the perioperative management and outcomes. The primary objective of this original retrospective cohort study was to evaluate the incidence, risk factors, and postoperative impact of PPMV in pediatric living-donor liver transplant recipients at a tertiary-care centre in India (April 2012–March 2022). Results Sixty-four patients were included for the final analysis. The incidence of PPMV was 31.2% ( n = 20). Elevated serum lactate at the end of surgery (≥ 4.4 mmol/L) was the only independent predictor (OR 2.81, 95% CI 1.06–7.45, p = 0.038) of PPMV. Patients in the PPMV group had significantly longer ICU stay (26.3 ± 7.9 vs. 17.3 ± 2.2 days, p = 0.030) and hospital stay (57.8 ± 14.7 vs. 36.4 ± 10.2 days, p < 0.001). These patients also had higher rates of tracheostomy (30% vs. 0.4%, p = 0.004), re-exploration (60% vs. 18.2%, p < 0.001), and graft dysfunction (15% vs. 0%, p = 0.009). Mortality at 28 days was significantly higher in this group (45% vs. 11.4%). Conclusion PPMV was found in nearly one-third of pediatric liver transplant recipients and was associated with unfavorable postoperative outcomes. Lactate ≥ 4.4 mmol/L was independently associated with PPMV and may serve as a useful marker for identifying children at increased risk. Trial registration ClinicalTrials.gov NCT05825703.