# Characteristics and Outcome of Partial Liver Transplant among Pediatrics in a Referral Transplant Center in Iran from 2010 to 2020

## TL;DR

This study analyzed liver transplant outcomes in 563 Iranian children from 2010 to 2020, identifying factors like weight, blood transfusions, and donor type that affect rejection and mortality.

## Contribution

The study identifies specific preoperative, intraoperative, and postoperative factors influencing liver transplant outcomes in pediatric patients in Iran.

## Key findings

- 21.1% of patients experienced post-transplant rejection, with factors like platelet transfusion and CMV increasing risk.
- 36.1% mortality was observed, with PNF and bleeding as significant postoperative risk factors.
- Living donor transplants were more common, and cholestatic and metabolic diseases were the leading indications.

## Abstract

Liver transplantation (LT) is a critical intervention for pediatric patients with advanced liver failure. This study aimed to assess the impact of perioperative factors on LT outcomes in pediatric patients

This retrospective cohort study, conducted from 2010-2020, included 563 pediatric patients who underwent LT in Shiraz, Iran. Most patients received liver grafts from living donors due to cholestatic and metabolic diseases, and all had complete medical and laboratory records. Data were analyzed using various regression models (Cox, linear, and logistic) in SPSS software (version 22).

Of the 563 patients who underwent LT, 436 received livers from living donors and 127 from deceased donors. The primary diagnoses included cholestatic diseases (44.4%) and metabolic diseases (34.1%). Post-transplant rejection and mortality rates were 21.1% (119 patients) and 36.1% (203 patients), respectively. Preoperative factors associated with rejection included weight (HR=1.01, P=0.01) and albumin (HR=0.69, P=0.03). Postoperative factors influencing rejection included platelet transfusion (HR=2.12, P=0.03), primary non-function (PNF) (HR=4.6, P=0.01), cytomegalovirus (CMV)(HR=1.78, P=0.005), and convulsion (HR=1.93, P=0.007). Preoperative factors that affect mortality were age (HR=0.89, P<0.001), alanine aminotransferase (ALT) (HR=1, P=0.047), and hemoglobin levels (HR=0.91, P=0.03). Intraoperative factors influencing mortality included cold ischemia duration (HR=0.98, P=0.048) and anhepatic blood loss (HR=1.02, P<0.001). Postoperative factors associated with mortality included fresh frozen plasma (FFP) transfusion (HR=1.7, P=0.004), bleeding (HR=2.17, P=0.009), bowel perforation (HR=2.55, P=0.01), and PNF (HR=11.24, P<0.001).

Optimizing perioperative care practices could significantly improve LT outcomes in pediatric patients.