Intraoperative Hemodynamic and Metabolic Stress as Determinants of Prolonged Intensive Care Unit Stay in Pediatric Liver Transplantation.

BACKGROUND

This study aimed to identify perioperative determinants of prolonged intensive care unit (ICU) stay in a consecutive cohort of pediatric liver transplant recipients, with emphasis on intraoperative hemodynamic and metabolic variables.

METHODS

This retrospective, single-center cohort study included 112 consecutive pediatric patients who underwent orthotopic liver transplantation (LT). The primary outcome was ICU length of stay ≥7 days. A multivariable binary logistic regression model was constructed using preoperative and intraoperative variables exclusively, following formal multicollinearity assessment with cluster-based variable selection. Discriminative performance was assessed by receiver operating characteristic analysis with bootstrap-derived CIs.

RESULTS

Thirty-two patients (28.6%) experienced prolonged ICU stay. In a model limited by a low events-pervariable ratio (EPV 4.0), 2 variables were associated with prolonged ICU stay: higher graft-to-recipient weight ratio (GRWR; odds ratio [OR] = 1.840, 95% CI: 1.087-3.114; P = .023) and lower preoperative hemoglobin (OR = 0.715, 95% CI 0.521-0.981; P = .038). Peak intraoperative lactate demonstrated moderate standalone discriminative performance (area under the curve 0.745; optimal threshold 6.0 mmol/L, sensitivity 59.4%, specificity 88.7%), without retaining significance in the multivariable model owing to collinearity. Prolonged ICU stay was associated with significantly higher rates of reintubation (40.6% vs. 9.0%; P < .001) and 30-day mortality (31.2% vs. 8.9%; P = .007).

CONCLUSION

Prolonged ICU stay in pediatric LT was associated with higher GRWR and lower preoperative hemoglobin. Peak intraoperative lactate showed moderate discriminative performance and a strong continuous association with ICU duration. These findings highlight perioperative correlates of ICU utilization that may inform risk stratification and warrant prospective evaluation. Cite this article as: Şahin T, Kavaklı AS, Aydin A, et al. Intraoperative hemodynamic and metabolic stress as determinants of prolonged ICU stay in pediatric liver transplantation. Eurasian J Med. 2026, 58(4), 1516, doi: 10.5152/eurasianjmed.2026.261516.