Infant liver transplants and morbidity

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    I have some questions for you folks whose units recover recover infants and children post-op liver transplantation. Our unit hasn't got a great track record with our infants so I'm trying to figure out what we could be doing differently. The largest part of my mind tells me that it has more to do with the surgeon/surgery than it does with us but you just never know!

    How young and small do you go? Are there differences in the post-operative course of smaller kids, like the ~6 month-old 7-8 kg kids, than for the older 12-18 month-old >10 kg kids? What's your typical LOS for these smaller kids? How many of them come back with open abdomens and how long do they typically stay open? Is there any difference between the cadaver donor and living related donor outcomes? What do you do about anticoagulation? How often do you see AKI and/or chronic renal failure? What's the longest stay you've had with a positive outcome?

    We're struggling with a little person who has been with us for a long time with an open abdomen and has had complication after complication, on and off the vent, needing renal replacement, still needing lots of blood products, and seems not to be going anywhere in a hurry. We've had others in similar straits and I'd like to know what we're missing.
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    unfortunately we don't do liver/small bowel transplants at my facility. Another hospital in my city, while it doesn't specialize in peds, was one of the first centers to begin liver/bowel transplants in the country and are considered well established. They do have a PICU for this purpose (and they get other picu patients as well) but where they're so well established & well known I guess it doesn't make sense for our hospital to try to start one when there is a great center just a few miles across the very small city. We do have an intestinal rehab program and a great GI program and do essentially everything but the transplant so kiddos that need transplant will go there but the docs work in conjunction with one another so long term follow up can continue at the children's hospital.

    Sorry I can't help


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