Perioperative mortality after pediatric liver transplantation

On April 1, 1984 a system was instituted at the University of Minnesota where washed, packed red blood cells were warmed and transfused directly into the central circulation through a large bore catheter during pediatric liver transplantation. To determine whether this change affected the perioperative morbidity and mortality, we performed a cohort study of the 158 pediatric patients who underwent liver transplantation at the University of Minnesota from November 3, 1964 to March 15, 1995. Four of the 28 patients (14.3%) transplanted before April 1, 1984 died of intraoperative hyperkalemia. None of the 130 patients recipient transplanted after this date died of this complication (p < 0.001). Similarly four recipients (14.3%) transplanted before April 1, 1984 died of hemorrhage within seven days of surgery, compared with only two patients (1.5%) transplanted after this date (p < 0.01). Improvement in the anesthetic and perioperative care of pediatric liver transplant recipients has resulted in reduced early mortality and eliminated hyperkalernia as a cause of intraoperative death.