Association between central venous pressure and postoperative pulmonary complications in living-donor liver transplantation for pediatric patients

doi:10.4240/wjgs.122362

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Sep 27, 2026; 18(9): 122362
Published online Sep 27, 2026. doi: 10.4240/wjgs.122362

Table 1 Baseline characteristics of the study participants

Characteristics	All participants (n = 426)	Patients without PPCs (n = 216)	Patients with PPCs (n = 210)	P value
Sex				0.044
Female	246 (57.7)	135 (62.5)	111 (52.9)
Male	180 (42.3)	81 (37.5)	99 (47.1)
Age (month)	8.0 (6.0, 15.8)	8.0 (6.0, 19.8)	8.0 (6.0, 12.0)	0.16
Weight (kg)	7.5 (6.5, 11.0)	7.5 (6.5, 11.0)	7.5 (6.5, 11.4)	0.789
PELD score	15.0 (4.0, 21.0)	15.0 (3.0, 23.0)	15.5 (5.0, 20.0)	0.881
Pathogeny				0.701
Biliary atresia	398 (93.4)	204 (94.4)	194 (92.4)
Metabolic pathology	19 (4.5)	8 (3.7)	11 (5.2)
Others	9 (2.1)	4 (1.9)	5 (2.4)
History of Kasai operation	294 (69.0)	130 (60.2)	164 (78.1)	< 0.001
Peroperative laboratory tests
WBC count (× 10⁹)	10.9 ± 5.8	10.5 ± 5.9	11.2 ± 5.8	0.254
RBC count (× 10¹²)	3.5 ± 0.6	3.5 ± 0.6	3.5 ± 0.6	0.793
HGB (g/L)	93.7 ± 17.3	94.0 ± 17.9	93.4 ± 16.6	0.721
PLT count (× 10⁹)	187.0 (116.5, 266.0)	184.0 (108.0, 254.0)	188.5 (129.5, 279.8)	0.147
INR	1.3 (1.1, 1.8)	1.3 (1.1, 1.8)	1.3 (1.1, 1.7)	0.537
PT (second)	15.0 (12.6, 19.6)	14.7 (12.5, 19.9)	15.3 (12.6, 18.8)	0.729
APTT (second)	39.9 (36.0, 46.4)	39.2 (36.0, 45.9)	40.4 (36.2, 47.1)	0.5
ALB (g/L)	35.1 ± 5.4	35.3 ± 5.5	34.9 ± 5.3	0.56
ALT (U/L)	110.0 (62.5, 179.8)	113.4 (62.9, 190.5)	99.6 (61.9, 176.6)	0.352
AST (U/L)	185.0 (109.1, 302.8)	181.4 (108.0, 324.7)	187.6 (111.3, 282.5)	0.441
TBIL (μmol/L)	209.3 (52.0, 306.7)	210.6 (44.6, 315.8)	207.9 (63.8, 288.1)	0.615
DBIL (μmol/L)	168.0 (41.2, 251.6)	170.0 (42.0, 259.8)	165.6 (41.1, 240.1)	0.483
Cr (μmol/L)	14.0 (12.0, 19.0)	15.0 (12.0, 19.0)	14.0 (12.0, 19.0)	0.731
ALP (U/L)	683.2 (440.2, 969.5)	671.5 (421.5, 892.2)	693.2 (455.0, 1036.2)	0.12
GGT (U/L)	249.8 (94.0, 501.5)	228.0 (76.0, 462.5)	284.5 (103.8, 542.2)	0.105
Intraoperative variables
Ascites amount (mL)	20.0 (0.0, 50.0)	20.0 (0.0, 50.0)	30.0 (0.0, 50.0)	0.423
GRWR	3.1 ± 1.2	3.2 ± 1.2	3.1 ± 1.2	0.648
Cold ischemia time (minute)	87.0 (71.0, 105.0)	84.5 (71.0, 101.0)	89.0 (71.0, 109.5)	0.216
Anhepatic phase (minute)	50.6 ± 21.6	49.0 ± 24.2	52.3 ± 18.6	0.114
CVP (cmH₂O)	6.0 (4.0, 8.0)	7.0 (5.0, 8.6)	5.0 (3.0, 8.0)	< 0.001
HGB (g/L)	83.6 ± 15.6	82.4 ± 13.9	84.9 ± 17.1	0.099
MBP (mmHg)	59.9 ± 10.6	59.6 ± 9.1	60.1 ± 11.9	0.662
Lactate (mmol/L)	2.5 (1.9, 3.4)	2.6 (2.0, 3.6)	2.5 (1.9, 3.2)	0.137
Fluid transfusion (mL/kg)	182.0 ± 81.4	182.5 ± 81.6	181.5 ± 81.3	0.901
Blood loss (mL)	300.0 (200.0, 400.0)	300.0 (200.0, 400.0)	300.0 (200.0, 400.0)	0.76
Urine (mL)	450.0 (300.0, 698.8)	400.0 (280.0, 680.0)	490.0 (300.0, 700.0)	0.114
Blood transfusion (U)	2.0 (1.5, 3.0)	2.0 (1.4, 2.5)	2.0 (1.5, 3.0)	0.148
Plasma (mL)	0.0 (0.0, 200.0)	0.0 (0.0, 200.0)	0.0 (0.0, 200.0)	0.569
Intraoperative fluid balance (mL)	636.2 (262.2, 1021.3)	669.5 (224.5, 1089.9)	602.0 (271.4, 935.0)	0.295
IR events	202 (47.4)	85 (39.4)	117 (55.7)	< 0.001
Adrenaline administration (µg)	2.0 (1.0, 4.0)	2.0 (0.0, 3.0)	2.0 (1.0, 5.0)	< 0.001
Surgery duration (minute)	537.3 ± 95.9	522.4 ± 86.2	552.6 ± 103.0	0.001
Postoperation
Mechanical ventilation duration (minute)	222.0 (147.0, 429.5)	219.0 (143.0, 446.0)	224.0 (156.8, 413.0)	0.776
Unplanned intubation	21 (5.0)	3 (1.4)	18 (8.7)	< 0.001
EAD	112 (26.3)	59 (27.3)	53 (25.2)	0.626
ICU duration (day)	2.0 (1.5, 2.5)	2.0 (1.5, 2.5)	2.0 (1.6, 3.0)	0.047
Hospitalization (day)	26.0 (20.0, 33.0)	25.0 (20.0, 31.8)	26.0 (20.0, 36.0)	0.377

Continuous variables are expressed as the mean ± SD for normally distributed data or as the median (interquartile range) for non-normally distributed data. Categorical variables are presented as n (%). PPC: Postoperative pulmonary complication; PELD: Pediatric end-stage liver disease; WBC: White blood cell; RBC: Red blood cell; HGB: Hemoglobin; PLT: Platelet count; INR: International normalized ratio; PT: Prothrombin time; APTT: Activated partial thromboplastin time; ALT: Alanine aminotransferase; ALB: Albumin; AST: Aspartate aminotransferase; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; Cr: Creatinine; CVP: Central venous pressure; MBP: Mean blood pressure; GRWR: Graft-to-recipient weight ratio; IR: Ischemia-reperfusion; EAD: Early allograft dysfunction; ICU: Intensive care unit.

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Table 2 Multivariate logistic regression analysis for the study participants

CVP (cmH₂O)	Crude model		Minimally adjusted model		Fully adjusted model
CVP (cmH₂O)	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
CVP	0.90 (0.85-0.96)	0.001	0.90(0.85-0.96)	0.002	0.91 (0.85-0.97)	0.007
CVP ≤ 6
Yes	Reference		Reference		Reference
No	0.54 (0.37-0.8)	0.002	0.54 (0.36-0.8)	0.002	0.55 (0.36-0.84)	0.005
CVP (cut)
CVP (< 5)	Reference		Reference		Reference
CVP (5-10)	0.46 (0.3-0.71)	0.001	0.46 (0.30-0.72)	0.001	0.45 (0.28-0.72)	0.001
CVP (> 10)	0.41 (0.22-0.76)	0.005	0.4 (0.21-0.75)	0.004	0.45 (0.23-0.9)	0.023
P for trend		0.001		0.001		0.003

Crude model: No other covariates were adjusted. Minimally adjusted model: We adjusted age + sex. Fully adjusted model: We adjusted age + sex + cold ischemia time + blood loss + urine + liquid transfusion + blood transfusion + ischemia-reperfusion + anthepatic phase time + pediatric end-stage liver disease score. CVP: Central venous pressure; OR: Odds ratio; 95%CI: 95% confidence interval.

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Table 3 Threshold effect analysis of central venous pressure on postoperative pulmonary complications

Threshold of CVP	OR	95%CI	P value	P for log likelihood ratio test
< 9.281 (cmH₂O)	0.834	0.752-0.925	0.0006	0.018
≥ 9.281 (cmH₂O)	1.193	0.847-1.68	0.3127	0.018

Adjustment factors included age + sex + cold ischemia time + blood loss + urine + liquid transfusion + blood transfusion + ischemia-reperfusion + anthepatic phase time + pediatric end-stage liver disease score. CVP: Central venous pressure; OR: Odds ratio; 95%CI: 95% confidence interval.

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Citation: 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
URL: https://www.wjgnet.com/1948-9366/full/v18/i9/122362.htm
DOI: https://dx.doi.org/10.4240/wjgs.122362

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]

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