Intensive care management to reduce morbidities following pediatric liver transplantation in Indonesia

Purpose: Outcome of pediatric liver transplant patients is affected by various factors, including critical care management in the early phase following surgery. This article focuses on early recognition of complications in pediatric liver transplant patients in Pediatric Intensive Care Unit (PICU). In particular, this article highlights the common problem in post-liver transplant pediatric patients in Indonesia, and the strategies to optimize recovery and minimize complications. Almost every system organ is affected by the surgery and medications given intra- and post-operatively. Careful monitoring and appropriate management are needed to ensure long-term success of surgery and prevent both early and late complications. Early extubation is recommended, however some may need PEEP titration to obtain optimal oxygenation. Advanced hemodynamic monitoring paired with clinical signs is recommended for optimal perfusion and ventriculo-arterial coupling. Routine electrolytes examination and neurological assessment are needed. Infection control and immunosuppression have to be optimized. Early enteral nutrition, nutritional support for recovery is needed, however should be gradually administered in malnourished patients. Conclusion: Early detection of post-transplant complications must be identified to ensure appropriate management is given as soon as possible. The ultimate goal is to retain graft acceptance as long as possible and the reduction of morbidity and mortality post-transplantation.