Background
Children with end‐stage liver disease and multi‐organ failure, previously considered as poor surgical candidates, can now benefit from liver transplantation (LT). They often need prolonged mechanical ventilation (MV) post‐LT and may need tracheostomy to advance care. Data on tracheostomy after pediatric LT are lacking.
Method
Retrospective chart review of children who required tracheostomy in the peri‐LT period in a large, freestanding quaternary children's hospital from 2014 to 2019.
Results
Out of 205 total orthotopic LTs performed in 200 children, 18 (9%) required tracheostomy in the peri‐transplant period: 4 (2%) pre‐LT and 14 (7%) post‐LT. Among those 14 needing tracheostomy post‐LT, median age was 9 months [IQR = 7, 14] at LT and 10 months [9, 17] at tracheostomy. Nine (64%) were infants and 12 (85%) were cirrhotic at the time of LT. Seven (50%) were intubated before LT. Median MV days prior to LT was 23 [7, 36]. Eight (57%) patients received perioperative continuous renal replacement therapy (CRRT). The median MV days from LT to tracheostomy was 46 [33, 56]; total MV days from initial intubation to tracheostomy was 57 [37, 66]. Four (28%) children died, of which 3 (21%) died within 1 year of transplant. Total ICU and hospital length of stay were 92 days [I72, 126] and 177 days [115, 212] respectively. Among survivors, 3/10 (30%) required MV at home and 8/10 (80%) were successfully decannulated at 400 median days [283, 584].
Conclusion
Tracheostomy though rare after LT remains a feasible option to support and rehabilitate critically ill children who need prolonged MV in the peri‐LT period.