International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
International Journal of Celiac Disease. 2021, 9(1), 12-15
DOI: 10.12691/ijcd-9-1-4
Open AccessArticle

In a Time of Pandemic: Predictors for Post-transplant Respiratory Complications

Bhavin Vasavada1,

1Consultant Hepatobiliary and Liver Transplant Surgeon, India

Pub. Date: January 21, 2021

Cite this paper:
Bhavin Vasavada. In a Time of Pandemic: Predictors for Post-transplant Respiratory Complications. International Journal of Celiac Disease. 2021; 9(1):12-15. doi: 10.12691/ijcd-9-1-4


Introduction: Biliary atresia is commonly associated with malnutrition and failure to thrive. Very few studies have been published on the impact of preoperative malnutrition on post-transplant outcomes in these children. Material and Methods: 110 children underwent living donor liver transplantation from January 2003 to March 2013. Pre-transplant malnutrition was defined according to z scores for the weight for age and height for age as per who definition. Patients having both Z score of < -2 were compared with the control group. Statistical analysis was done using SPSS version 21 (IBM). Results: 39 children out of 110 were having z score for the weight for age < -2. There was no statistical difference between PELD score, graft weight, GRWR, intraoperative blood loss between to groups. 22 out of 39 patients in malnourished group developed clavein grade 3, grade 4 complications and 32 patients out of 71 in the control group developed clavien grade 3 grade 4 complications. (p= 0.318). The overall mortality rate was 4.5% and mortality rates in the malnourished vs control group were respectively 7.69% and 2.81% (p= 0.278). A total of 14 patients developed postoperative pulmonary complications. Pulmonary complications were significantly high in the malnourished group. p=0.003. Conclusion: Preoperative malnutrition is associated with a high postoperative pulmonary complication rate in liver transplantation for biliary atresia.

biliary atresia liver transplants pulmonary complication

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Perlmutter DH, Shepherd RW. Extrahepatic biliary atresia: A disease or a phenotype? HEPATOLOGY 2002; 35: 1297-1304.
[2]  Sokol RJ, Mack D, Narkewicz MR, Karrer FM. Pathogenesis and outcome of biliary atresia: Current concepts. J Pediatr Gastroenterol Nutr 2003: 37: 4-21.
[3]  Karrer FM, Bensard DD. Neonatal cholestasis. Semin Pediatr Surg 2000; 9: 166-169.
[4]  Chardot C, Carton M, Spire-Bendelac N, Le Pommelet C, Golmard JL, Auvert B. Epidemiology of biliary atresia in France: a national study 1986-96. J Hepatol 1999; 31: 1006-1013.
[5]  Karrer FM, Price MR, Bensard DD, Sokol RJ, Narkewicz MR, Smith DJ, et al. Long-term results with Kasai operation for biliary atresia. Arch Surg 1996; 131: 493-496.
[6]  Pierro A, Koletzko B, Carnielli V, Superina RA, Roberts EA, Filler RM, et al. Resting energy expenditure is increased in infants and children with extrahepatic biliary atresia. J Pediatr Surg. 1989; 24: 534-8.
[7]  Pierre A. Clavien, Jeffrey Barkun, Michelle L. de Oliveira, Jean Nicolas Vauthey, Daniel Dindo, MD, Richard D. Schulick, et al The Clavien-Dindo Classification of Surgical Complications Five-Year Experience Ann Surg 2009; 250: 187-196.
[8]  Barshes NR, Chang IF, Karpen SJ, Carter BA, Goss JA. Impact of pretransplant growth retardation in pediatric liver transplantation. J Pediatr Gastroenterol Nutr. 2006; 43: 89-94.
[9]  Estella M. Alonso1 Growth and Developmental Considerations in Pediatric Liver Transplantation. LIVER TRANSPLANTATION 14: 585-591, 2008.
[10]  Shepherd RW, Chin SE, Cleghorn GJ, Patrick M, Ong TH, Lynch SV, et al. Malnutrition in children with chronic liver disease accepted for liver transplantation: clinical profile and effect on outcome. J Paediatr Child Health 1991; 27: 295-299.
[11]  Sullivan JS, Sundaram SS, Pan Z, Sokol RJ Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation. Liver Transpl. 2012; 18: 120-8.
[12]  Figueiredo F, Dickson ER, Pasha T, Kasparova P, Therneau T, Malinchoc M, et al. Impact of nutritional status on outcomes after liver transplantation. Transplantation. 2000; 70: 1347-1352.
[13]  Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Ono H, Akiyama H Immunonutrition risk factors of respiratory complications after esophagectomy. Nutrition. 2004r; 20: 364-7.
[14]  Neto JS, Pugliese R, Fonseca EA, Vincenzi R, Pugliese V, Candido H, Four hundred thirty consecutive pediatric living donor liver transplants: variables associated with posttransplant patient and graft survival. Liver Transpl. 2012; 18: 577-84.
[15]  DeRusso PA, Ye W, Shepherd R, Haber BA, Shneider BL, Whitington PF, et al.; for Biliary Atresia Research Consortium. Growth failure and outcomes in infants with biliary atresia: a report from the Biliary Atresia Research Consortium. Hepatology 2007; 46: 1632-1638.
[16]  Soltys KA, Mazariegos GV, Squires RH, Sindhi RK, Anand R; for SPLIT Research Group. Late graft loss or death in pediatric liver transplantation: an analysis of the SPLIT database. Am J Transplant 2007; 7; 2165-2171.