title: Anesthetic management in pediatric orthotopic liver transplant for fulminant hepatic failure and end-stage liver disease.
abstract: OBJECTIVE
  We assessed the anesthetic management and short-term morbidity and mortality in pediatrics patients who underwent an orthotopic liver transplant for fulminant hepatic failure or end-stage liver disease in a university hospital.
  
  
  METHODS
  We retrospectively analyzed the records of children who underwent orthotopic liver transplant from May 2002 to May 2012. Patients were categorized into 2 groups: group fulminant hepatic failure (n=22) and group end-stage liver disease (n=19). Perioperative data related to anesthetic management and intraoperative events were collected along with information related to postoperative course and survival to hospital discharge.
  
  
  RESULTS
  Mean age and weight for groups fulminant hepatic failure and end-stage liver disease were 8.6 ± 2.7 years and 10.8 ± 3.8 years (P = .04) and 29.2 ± 11.9 kg and 33.7 ± 16.9 kg (P = .46). There were no differences between the groups regarding length of anhepatic phase (65 ± 21 min vs 73 ± 18 min, P = .13) and operation time (9.1 ± 1.6 h vs 9.5 ± 1.8 h, P = .23). When compared with the patients in group fulminant hepatic failure, those in group end-stage liver disease more commonly had a Glasgow Coma score of 7 or less (32% vs 6%, P = .04). Compared with patients in group fulminant hepatic failure, those in group end-stage liver disease were more frequently extubated in the operating room (31.8% versus 89.5% P < .001). Postoperative duration of mechanical ventilation (2.78 ± 4.02 d vs 2.85 ± 10.21 d, P = .05), and the mortality rates at 1 year after orthotopic liver transplant (7.3% vs 0%, P = .09) were similar between the groups.
  
  
  CONCLUSIONS
  During pediatric orthotopic liver transplant, those children with fulminant hepatic failure require more intraoperative fluids and more frequent perioperative mechanical ventilation than those with end-stage liver disease.
authors.affiliation: Department of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Aynur
authors.initials: A
authors.lastname: Camkıran
authors.forename: Coşkun
authors.initials: C
authors.lastname: Araz
authors.forename: Sevgi
authors.initials: S
authors.lastname: Seyhan Ballı
authors.forename: Adnan
authors.initials: A
authors.lastname: Torgay
authors.forename: Gökhan
authors.initials: G
authors.lastname: Moray
authors.forename: Arash
authors.initials: A
authors.lastname: Pirat
authors.forename: Gülnaz
authors.initials: G
authors.lastname: Arslan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D061646:Operative Time; D019990:Perioperative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey