Early Postoperative Course

At the end of the transplantation procedure the child is usually transferred from the operating room to the intensive care unit. The early postoperative period is the time of highest risk for morbidity and mortality, arising from technical and non-technical complications. These must be promptly recognized and treated by a multidisciplinary team composed of surgeons, intensivists, hepatologists and specially trained pediatric intensive care nurses.
In the intensive care unit, appropriate continuous monitoring of vital signs and frequent laboratory monitoring are performed, combined with careful observation of hemodynamic, respiratory, and neurological functions. Urine output and output from drains and the naso-gastric tube are observed for their characteristics and amount, for the monitoring of fluid loss and the development of surgical complications. Liver function must be assessed at least twice a day by biochemical evaluation and bile production. Indirect signs of good graft function are patient’s awakening from anesthesia and good urine output.
Several factors influence liver function recovery after transplantation and may cause primary nonfunction of the transplanted liver. Different patterns of liver function recovery have been documented according to the type of the transplanted graft.
In our experience post-transplant graft functional recovery $ tended to be slower in split liver recipients when compared to children receiving a whole liver. However liver function tests were comparable one week after transplantation and thereafter.
Pediatric patients with liver failure are frequently malnourished preoperatively, and some will be unable to eat for several days after transplantation. To provide early nutritional support, parenteral nutrition is usually started on the first postoperative day, and enteral nutrition as soon as possible.