Increased morbidity associated with secondary abdominal closure in pediatric liver transplantation.

BACKGROUND

The discrepancy in size between donor and recipient presents a complex challenge in pediatric liver transplantation (PLT), often necessitating secondary abdominal closure to prevent abdominal compartment syndrome. The aim of this study is to determine the variables associated with an increased risk of requiring secondary closure in PLT.

METHODS

The retrospective study analyzed all primary liver transplantations performed in patients under 18 years of age from January 2014 to July 2022. The primary endpoint was the risk of secondary abdominal closure. Variables analyzed included pretransplant status, perioperative and postoperative data.

RESULTS

A total of 664 PLT recipients were identified, of which 58 required secondary abdominal closure (8.7%). Most patients had biliary atresia (=412, 62.0%), followed by metabolic diseases (=78, 11.7%). Statistical difference were found in donor gender (=0.020) and the recipient-to-donor body weight ratio (RDBW), which was lower in the secondary closure group (0.1±0.1 0.2±0.27; =0.001), lower in secondary closure. The mean hospital and intensive care unit (ICU) stay after PLT was significantly longer in the intervention group compared to those with primary abdominal closure (24.4±20.4 days 12.5±13.1 days, <0.001). Multivariable Cox regression analysis identified male donor as an independent risk factor for secondary abdominal closure (hazard ratio 1.9, =0.030).

CONCLUSIONS

Patients requiring secondary closure were smaller, had a lower RDBW, and received grafts with a higher graft-to-recipient weight ratio (GRWR), Graft size modulation and secondary abdominal closure are currently the techniques used to prevent compartment syndrome in PLT, particularly for children with low body weight.