Anesthetic management in pediatric liver transplantation: a comparison of deceased or live donor liver transplantations

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Abstract
Pediatric liver transplantations (LT) are becoming increasingly more common in the treatment of a child with end-stage liver disease. The aim of this study was to evaluate the perioperative anesthetic experience of pediatric patients undergoing deceased and live donor liver transplantations. We performed a chart review of 164 patients between December 1997 and February 2009 in a retrospective cohort study design. Patient characteristics, operational variables, hemodynamic course, blood and fluid requirements, and extubation rates were evaluated in both deceased [deceased donor liver transplantation (DDLT, n = 56)] and live donor liver transplantation (LDLT, n = 101) patients. The LDLT patients had a lower mean age and body weight than the DDLT patients (p < 0.05). The mean operation time was significantly longer and the mean anhepatic time was shorter for LDLT patients than for DDLT patients. The mean red blood cell (RBC) count and crystalloid and colloid requirements were significantly higher in LDLT patients. Relative to DDLT patients, significantly more patients in the LDLT group did not require fresh frozen plasma. The overall success rates of immediate extubation at the end of surgery were 74% in LDLT patients and 49% in DDLT patients (p = 0.086). The immediate extubation rate by year, including both groups, increased from 0% in 1997 to 95.6% in 2008. The results of this study show that among pediatric patients LDLT continues to become an ‘obligatory’ option that is associated with longer operation times and higher RBC and fluid requirements than DDLT. As a marker of successful LT, higher extubation rates immediately following surgery is achievable for both pediatric LDLT and DDLT patients.