Resumen

GONZALEZ, Luis Fernando; ARIZA CADENA, Fredy; VIDAL, Carlos Andrés  y  ZULUAGA, Diego. Trasplante hepático en niños menores de 10kg: Factores perioperatorios y mortalidad temprana. Rev. colomb. anestesiol. [online]. 2007, vol.35, n.1, pp.9-19. ISSN 0120-3347.

Methods: Our Institutional Database was used to find paediatric patients under 10 kg who underwent orthotopic liver transplantation (OLT) during a period of 10 years. Relevant perioperative demographic and clinical variables and the severity status at the moment of surgery, according to the Paediatric End Liver Disease Score (PELD) were recorded. Each patient was followed for 3 months or until his/her death. Once the data was stratified by type of donor and year of procedure, perioperative variables were analyzed for a significant association with important morbid outcomes and early postoperative mortality. Results: Thirty patients were identified. No significant differences were found between OLT techniques when comparing preoperative status, surgical events or mortality. Severe thrombocytopenia and hipoalbuminemia were significantly associated with early mortality [RR: 3.5 (IC95%: 1.94-6.18) p=0.03; RR: 2.7 (IC95%: 1.1-7.21p = 0.04; respectively]. Patients whose suffer severe intraoperative hypothermia (< 35ºC) had 70% more risk of postoperative death [RR: 3.5 (IC95% 1.94-6.28) = 0.03]. Combined use of colloids improved survival in a statistical significant way (RA: -0.33; p=0.02). In the postoperative period, severe sepsis and acute neurological events was correlated significantly with mortality [RR: [3.5 (IC95% 1.2-10.9) p=0.01; RR: 3.5 (IC95% 1.94-6.28) p=0.03; respectively]. Conclusion: There is a direct relation between hipoalbuminemia and thrombocytopenia with early mortality in patients less than 10 Kg. underwent to OLT. Prolonged times in surgery room and hypothermia are associated with major postoperative complications and death. Severe sepsis and acute neurological events must be considered ominous events in OLT. Although important advances in perioperative care have developed, optimization of the preoperative conditions of these patients needs to be enforced.

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