Risk factors for early mortality (within 90 days) in pediatric liver transplant recipients

Liver transplantation (LT) is a potential treatment for acute or chronic conditions of the liver that cause the body to function irreversibly and severely. Studies have been conducted on the factors influencing early post-transplant mortality but have not defined any relationship between these factors and the cause. This study aimed to define the causes of early death at 90 days post-transplantation in children who underwent transplantation at the Shiraz Organ Transplantation Center. Patients and methods. This cross-sectional study included 145 pediatric transplant recipients who died within 3 months after the first transplantation at the Shiraz Organ Transplant Center affiliated with the Shiraz University of Medical Sciences between 2020 and 2022. Data collection included recipient characteristics, anesthesia data, surgical techniques, donor characteristics, and cause of death. Data were analyzed using SPSS Software Version 24. Results. A total of 145 people were examined, early death occurred in 35 of them. Homogeneity between the two groups was maintained in all demographic variables except weight percentile. The injection of sympathetic mimic drugs and the need for portal thrombectomy were significantly higher in the early death group, and the use of tacrolimus and prednisolone was significantly lower in this group. The type of biliary anastomosis was also statistically significantly different in the two groups. The occurrence of encephalopathy, bone marrow suppression, seizures, and kidney problems after transplantation, mechanical ventilation for more than 48 hours after transplantation, the occurrence of complications during the waiting period, and the occurrence of encephalopathy, gastrointestinal bleeding, and ascites before transplantation and malnutrition were significantly higher in the group that experienced early death, and primary non-function was the most common known cause of early death. The absence of encephalopathy after transplantation (OR = 0.003, p = 0.016), the absence of bone marrow suppression after transplantation (OR = 0.021, p = 0.010), and the absence of tacrolimus use (OR = 52.539, p = 0.003) could predict the occurrence of early death. Conclusion. The present study indicated that the occurrence of encephalopathy and bone marrow suppression after transplantation, as well as failure to take tacrolimus, are risk factors for early death in pediatric liver transplantation. Knowing the factors that may identify a specific cause of early death in the post-liver transplant period will allow us to more accurately stratify patients at high risk of death. Key words: liver transplantation, risk factors, early mortality