title: Outcome of critically-ill children after living-donor liver transplant.
abstract: OBJECTIVE
  The outcome of children who had living-donor liver transplant was analyzed according to their status before transplant, and we analyzed the outcome of critically ill patients.
  
  
  METHODS
  This was a retrospective analysis of children who received primary living-donor liver transplant at Kyoto University Hospital. According to the criteria of the United Network for Organ Sharing, we divided patients into 3 groups: Group A patients had been admitted to the intensive care unit before living-donor liver transplant; Group B patients were hospitalized but did not require intensive care unit stay; and Group C patients were living at home and underwent elective transplant.
  
  
  RESULTS
  A total 685 patients met inclusion criteria. Children in Group A were younger than Group B and received liver grafts from younger donors than Group B and C. Group A patients had marked impairment in liver and renal function and coagulation profile and needed higher volumes of fresh frozen plasma transfusions. Group A patients had significantly worse outcomes and early patient death than the other group; Group A patient survival was 68.3%, 63.2%, 60.1%, and 56.1% at 1, 5, 10, and 15 years after living-donor liver transplant (P < .0001). Group A had worse graft survival than other groups (P < .0001), and Group A graft survival was 68.3%, 65.9%, 54.1%, and 49.9% at 1, 5, 10, and 15 years. Low gamma-glutamyl transpeptidase was an independent risk factor for patient death in Group A (hazard ratio, 1.004; 95% confidence interval, 1.0-1.007) (P < .05). Group A patients had a higher rate of multidrug-resistant hospital-acquired infections.
  
  
  CONCLUSIONS
  Children who were admitted to the intensive care unit prior to living-donor liver transplant had marked impairment of pretransplant laboratory parameters and worse outcome than other groups.
authors.affiliation: From the Department of Anesthesia, Assiut University, Assiut, Egypt; and the Department of Anesthesia, King Abdullah Medical City, Mecca, Saudi Arabia.
authors.forename: Hamed
authors.initials: H
authors.lastname: Elgendy
authors.forename: Walid M
authors.initials: WM
authors.lastname: El Moghazy
authors.forename: Hanaa
authors.initials: H
authors.lastname: Nafady-Hego
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D017558:Elective Surgical Procedures; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007564:Japan; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D010343:Patient Admission; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome