Dong AL, Li HX, Jia LL, Sun Y, Gao W, Yu WL. Association between central venous pressure and postoperative pulmonary complications in living-donor liver transplantation for pediatric patients. World J Gastrointest Surg 2026; 18(9): 122362 [DOI: 10.4240/wjgs.122362]
Corresponding Author of This Article
Wen-Li Yu, PhD, Chief Physician, Department of Anesthesiology, Tianjin First Central Hospital, No. 24 Fukuang Road, Nankai District, Tianjin 300192, China. yzxwenliyu@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Dong AL, Li HX, Jia LL, Sun Y, Gao W, Yu WL. Association between central venous pressure and postoperative pulmonary complications in living-donor liver transplantation for pediatric patients. World J Gastrointest Surg 2026; 18(9): 122362 [DOI: 10.4240/wjgs.122362]
Ai-Li Dong, Hong-Xia Li, Department of Anesthesiology, First Central Hospital of Tianjin Medical University, Tianjin 300192, China
Li-Li Jia, Ying Sun, Wen-Li Yu, Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China
Wei Gao, Department of Hepatic Transplantation, Tianjin Key Laboratory of Organ Transplantation, Tianjin 300192, China
Author contributions: Dong AL and Li HX contributed equally to all aspects of this manuscript including study conception and design, data acquisition, analysis, and interpretation, and drafting of the article; Jia LL and Sun Y contributed to study conception and design, data analysis and interpretation, and drafting of the article; Gao W contributed to data acquisition; and Yu WL supervised the research and approved the final draft.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by Tianjin Horizontal Research Project, No. YLGX-MZ-2022008; Tianjin Key Clinical Speciality (Anaesthesiology) Construction Project; and Tianjin Key Medical Construction Project, No. TJYXZDXK-3-022C.
Institutional review board statement: This retrospective study was approved by the Institutional Review Board of First Central Hospital of Tianjin Medical University No. KYAP2025-153.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Wen-Li Yu, PhD, Chief Physician, Department of Anesthesiology, Tianjin First Central Hospital, No. 24 Fukuang Road, Nankai District, Tianjin 300192, China. yzxwenliyu@163.com
Received: April 20, 2026 Revised: June 30, 2026 Accepted: August 25, 2026 Published online: September 27, 2026 Processing time: 152 Days and 3 Hours
Abstract
BACKGROUND
Perioperative lung injury and postoperative pulmonary complications (PPCs) contribute substantially to respiratory morbidity and mortality and adversely affect outcomes in pediatric patients undergoing liver transplantation. In several surgical populations, different fluid management strategies have been associated with postoperative complications, particularly PPCs; however, this relationship remains unclear in pediatric liver transplantation.
AIM
To investigate the association between central venous pressure (CVP) and PPCs in pediatric patients undergoing living-donor liver transplantation (LDLT).
METHODS
We retrospectively reviewed pediatric patients who underwent LDLT between January 2019 and December 2024. The primary outcome was the incidence of PPCs. Multivariate logistic regression and restricted cubic spline analyses were used to evaluate the association between CVP and PPC incidence.
RESULTS
A total of 426 patients met the inclusion criteria, of whom 210 developed PPCs. A nonlinear association was observed between CVP and PPCs in pediatric LDLT recipients. In multivariate logistic regression analysis, CVP was independently associated with PPC incidence. After adjustment for potential confounders, each 1-unit increase in CVP was associated with a 9% reduction in the risk of PPCs [odds ratio (OR) = 0.91; 95% confidence interval (95%CI): 0.85-0.97; P = 0.007]. Threshold analysis showed that the OR for PPCs was 0.834 (95%CI: 0.752-0.925; P = 0.0006) among patients with CVP < 9.3 cmH2O.
CONCLUSION
An inverse association between CVP level and PPC incidence is observed among pediatric LDLT recipients with CVP < 9.3 cmH2O. Prospective longitudinal studies are warranted to establish causality and clarify the underlying mechanisms.
Core Tip: This retrospective study identified a novel J-shaped association between intraoperative central venous pressure (CVP) and postoperative pulmonary complications (PPCs) in 426 pediatric living-donor liver transplant recipients. Multivariate analysis demonstrated that each 1-unit increase in CVP was associated with a 9% reduction in PPC risk [odds ratio (OR) = 0.91, 95% confidence interval: 0.85-0.97, P = 0.007], with the strongest association observed at CVP < 9.3 cmH2O (OR = 0.834, P = 0.0006). These findings may provide insight into CVP as a modifiable factor for PPC mitigation in pediatric transplantation.
