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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Fluid Overload and Graft Injury Following Pediatric Liver Transplantation: A Single-Center Analysis

by
Sapir Bar
1,
Yael Mozer Glassberg
2,3,
Michael Gurevich
3,4,
Elhanan Nahum
1,3,
Avichai Weissbach
1,3,
Eytan Kaplan
1,3 and
Gili Kadmon
1,3,*
1
Pediatric Intensive Care Unit, Schneider Children’s Medical Center in Israel, 14 Kaplan Street, Petach Tikva 4920235, Israel
2
Gastroenterology Institute, Schneider Children’s Medical Center in Israel, Petach Tikva 4920235, Israel
3
Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
4
Pediatric Transplantation and Liver Surgery Unit, Schneider Children’s Medical Center in Israel,Petach Tikva 4920235, Israel
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(11), 3759; https://doi.org/10.3390/jcm14113759
Submission received: 27 April 2025 / Revised: 21 May 2025 / Accepted: 24 May 2025 / Published: 27 May 2025
(This article belongs to the Special Issue Clinical Insights into Pediatric Critical Care)
Versions Notes

Abstract

Background: We aimed to compare graft injury and complications after liver transplantation in children with higher versus lower fluid balance. Methods: In a cohort of 79 pediatric liver transplant recipients, we analyzed the associations of decreases in alanine aminotransferase (ALT) and bilirubin (delta ALT, delta bilirubin) with fluid balance in the first six postoperative days and associations of fluid balance with vascular complications and mean ALT one year after the transplantation. Results: Patients who developed vascular complications had significantly higher mean cumulative fluid balance during the first three postoperative days, as well as higher mean fluid balance on postoperative days 0 (POD0) and 2 (POD2) (p < 0.05), compared to those without complications. A negative correlation was observed between fluid balance and delta ALT on POD2. Additionally, patients with a cumulative fluid balance exceeding 200 mL/kg during the first three postoperative days had higher mean ALT levels one year after transplantation (p = 0.03). Conclusions: Fluid overload was associated with vascular complications and showed correlations with markers of graft injury. Prospective studies are needed to validate these findings and further clarify the role of fluid balance in pediatric liver transplantation.
Keywords: children; complications; fluid balance; hepatology; treatment; transaminases; vascular injury children; complications; fluid balance; hepatology; treatment; transaminases; vascular injury

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MDPI and ACS Style

Bar, S.; Mozer Glassberg, Y.; Gurevich, M.; Nahum, E.; Weissbach, A.; Kaplan, E.; Kadmon, G. Fluid Overload and Graft Injury Following Pediatric Liver Transplantation: A Single-Center Analysis. J. Clin. Med. 2025, 14, 3759. https://doi.org/10.3390/jcm14113759

AMA Style

Bar S, Mozer Glassberg Y, Gurevich M, Nahum E, Weissbach A, Kaplan E, Kadmon G. Fluid Overload and Graft Injury Following Pediatric Liver Transplantation: A Single-Center Analysis. Journal of Clinical Medicine. 2025; 14(11):3759. https://doi.org/10.3390/jcm14113759

Chicago/Turabian Style

Bar, Sapir, Yael Mozer Glassberg, Michael Gurevich, Elhanan Nahum, Avichai Weissbach, Eytan Kaplan, and Gili Kadmon. 2025. "Fluid Overload and Graft Injury Following Pediatric Liver Transplantation: A Single-Center Analysis" Journal of Clinical Medicine 14, no. 11: 3759. https://doi.org/10.3390/jcm14113759

APA Style

Bar, S., Mozer Glassberg, Y., Gurevich, M., Nahum, E., Weissbach, A., Kaplan, E., & Kadmon, G. (2025). Fluid Overload and Graft Injury Following Pediatric Liver Transplantation: A Single-Center Analysis. Journal of Clinical Medicine, 14(11), 3759. https://doi.org/10.3390/jcm14113759

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