Introduction: Liver transplantation is a life-saving measure for many patients; however, short and long-term complications after liver transplantation pose a significant risk. Transplant patients often seek care in pediatric emergency departments for various reasons. However, it can be challenging to differentiate between minor illnesses and life-threatening complications or rare diseases in these patients due to their diverse therapeutic regimes affecting multiple organ systems and causing immunosuppression.
Aim: The main aim of our study is to describe the clinical features of liver transplant patients visiting the pediatric emergency department and to identify risk factors that may lead to intensive care unit admission.
Methods: We retrospectively included pediatric liver transplant patients between 1-17 years old who visited the pediatric emergency department of Baskent University Hospital between 01/01/2023 and 31/12/2023. We noted main symptoms, laboratory tests, hospitalization status, and final diagnoses. Clinical and laboratory features of patients admitted to the Pediatric Intensive Care Unit (PICU) were compared with those who were not. Descriptive statistics were presented with frequencies for quantitative variables and mean and standard deviation or median and range for continuous variables. The chi-square test and independent sample t-test were used for variable comparisons, and p<0.05 was considered statistically significant.
Results: In a one-year period, 33 patients made a total of 108 visits to pediatric emergency department. Of these, 46.3% were girls, and the mean age was 7.79±4.40 years for all visits. The median post-transplant day at the time of the emergency department visit was  622 days (10-6189 days). The most common symptoms were vomiting (48.1%), fever (46.3%), rhinorrhea and cough (34.3%). The mean white blood cell count was 10.20±7.72 x103/µL, ALT was 53.72±71.84, and AST was 61.88±56.99 U/L. A total of 49 visits (45.4%) resulted in hospitalization. 5 visits (4.6%) were resulted in PICU admission, two of these patients died (1,8%). The final diagnosis were acute gastroenteritis in 23 patients (21,2%), upper respiratory tract infections in 23 patients (21,2%) and lower respiratory tract infections in 13 patients (12%). Cholangitis was diagnosed in 7 patients (6,5%), intraabdominal infection in 6 patients (5,6%) and sepsis in 5 patients (4,6%). Seizures (2 patients 1,8%) and sepsis (5 patients 4,6%) were significantly correlated with PICU admission (p=0.00). Post transplant day was significantly shorter in patients admitted to the PICU when compared with the whole group (518±324 days in PICU patients and 1498±1658 days in non PICU patients, p=0,000).
Conclusion: The most common diagnosis among pediatric liver transplant patients in the pediatric emergency department was respiratory and gastrointestinal infections. Serious infections were observed very infrequently. Half of the patients were hospitalized in wards, while a very small number required admission to the PICU. Nevertheless, physicians caring for liver transplant patients should be aware of serious complications that may occur in these patients and should closely monitor them, especially during the early transplant period when intensive immunosuppressive treatment regimens are employed.