# APBA Kısa Özet

This retrospective cohort study evaluated 102 pediatric recipients under 18 years of age who underwent living donor liver transplantation (LDLT) for cholestatic liver diseases between August 2015 and June 2024 at two Cairo transplant centers. Patients were stratified into three body weight groups: less than 10 kg (n=28), 10-15 kg (n=26), and more than 15 kg (n=48). The primary objective was to assess the effect of recipient body weight on postoperative complications and survival outcomes. Median age was 6 years, with a median body weight of 15 kg; 59.8% of recipients were male. The study compared demographic, operative, postoperative, and survival data across groups using appropriate statistical tests, with survival analyzed via Kaplan-Meier method and log-rank testing.

# Çalışma neyi araştırdı?

The research aimed to evaluate the effect of recipient body weight on postoperative complications and survival after LDLT for cholestatic liver diseases in children. A key question was whether recipients weighing less than 10 kg are at significantly higher risk for technical complications and poorer clinical outcomes compared to heavier groups.

# Yöntem

  • Tasarım: Retrospektif kohort çalışması.
  • Katılımcılar: 102 çocuk (59,8 % erkek), 2015‑2024 arasında iki Kahire transplantasyon merkezinde LDLT yapılanlar.
  • Ağırlık Grupları: <10 kg (n=28), 10‑15 kg (n=26), >15 kg (n=48).
  • Veri Toplama: Demografik, operatif, postoperatif ve hayatta kalma verileri tıbbi kayıtlarından toplanmıştır.
  • İstatistiksel Analiz: Grup karşılaştırmaları için χ² testi, ANOVA ve Kaplan‑Meier hayatta kalma analizi ile log‑rank testi kullanıldı.
  • Etik Onay: Çalışma ilgili kurum etik kurullarının onayını aldı; retrospektif doğası nedeniyle bireysel onay gerekmedi.

# Temel bulgular

  • Postoperatif pnömoni: <10 kg grubunda %51,7, 10‑15 kg’da %30,8, >15 kg’da %20,8 (p<0.05).
  • Portal ven trombozu: <10 kg’da %14,3, 10‑15 kg’da %3,8, >15 kg’da %2,1 (p<0.05).
  • Erken mortalite (30 gün): <10 kg %25,0, 10‑15 kg %19,2, >15 kg %14,6 (istatistiksel olarak anlamlı fark yok).
  • 1‑yıl yaşam oranı: <10 kg %71,4, 10‑15 kg %76,9, >15 kg %87,5 (p>0.05).
  • 3‑yıl yaşam oranı: <10 kg %71,4, 10‑15 kg %76,9, >15 kg %81,3 (p>0.05).
  • Ortalama değerler: Medyan yaş 6 yıl, medyan ağırlık 15 kg.

# Bulgular ne anlama geliyor?

Children weighing less than 10 kg at the time of LDLT have higher postoperative morbidity, particularly pneumonia and portal vein thrombosis, but achieve survival comparable to that of heavier recipients. Low body weight alone does not increase early mortality or compromise long-term survival. The increased complication rates in the smallest recipients likely reflect technical challenges and immune-related factors in this vulnerable subgroup, but the data support proceeding with transplantation in experienced centers.

# Klinik önem

  • Karar verme: Low body weight alone should not be considered a contraindication to pediatric LDLT, but perioperative care and complication monitoring should be intensified for children under 10 kg.
  • Merkez deneyimi: Results underscore that high-volume, experienced transplant centers are better equipped to manage low-weight recipients safely.
  • Hasta ve aile bilgilendirmesi: Families should be counseled that while low weight alone does not reduce survival chances, the risk of infection and thrombosis is higher, necessitating vigilant postoperative management.

# Sınırlılıklar

  • Retrospektif tasarım: Retrospective design limits causal inference; observed associations may be confounded by unmeasured factors.
  • Coğrafi sınırlama: The study was conducted at only two centers in Cairo; generalizability of results to global populations is uncertain.
  • Küçük örneklem: The <10 kg group included only 28 patients, limiting statistical power.
  • Eksik veri: Some potential risk factors, such as donor-recipient anatomical compatibility and specific immunosuppression protocols, were not detailed in the report.
  • Çıkar çatışması: Declared conflict of interest is unclear, which may introduce an additional layer of uncertainty in the interpretation of results.

APBA Yorumu: This study demonstrates that low-weight pediatric LDLT recipients can have similar survival outcomes to heavier patients when transplanted at experienced centers. However, the significantly higher morbidity, particularly regarding pneumonia and portal vein thrombosis, suggests that perioperative protocols and risk‑benefit assessments should be individualized. Further validation of these findings across diverse geographic and clinical settings is critical for refining transplant guidelines and policies.