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"Angka kesintasan dan kualitas hidup anak dengan penyakit hepatobilier kronik meningkat seiring dengan berkembangnya transplantasi hati. Insidens infeksi bakteri 36–79% pada 6 bulan pascatransplantasi dan mortalitasnya 3,0–10,6% pada 3 bulan pascatransplantasi. Pencegahan infeksi bakteri yang adekuat akan menurunkan angka morbiditas dan mortalitas serta meningkatkan kesintasan pasien. Penelitian ini bertujuan untuk mengetahui faktor risiko infeksi bakteri pada anak pascatransplantasi hati di Indonesia. Penelitian kohort retrospektif ini melibatkan pasien anak pascatransplantasi hati di RSUPN Dr. Cipto Mangunkusumo (RSCM) mulai Desember 2010 s/d April 2023 dengan metode total sampling. Subjek dibagi menjadi kelompok infeksi bakteri dan tanpa infeksi bakteri. Prevalens infeksi bakteri dari 63 subjek penelitian ini adalah 84,13%. Infeksi bakteri didominasi oleh hospital acquired infection (HAI) berupa infeksi daerah operasi (29,63%), ventilator-associated pneumonia (14,81%), dan catheter-related urinary tract infection (13,58%). Angka mortalitas terkait infeksi bakteri adalah 12,70%. Analisis multivariat menunjukkan lama rawat ICU ≥ 20 hari (RR 1,212, IK 95% 1,028 −1,426, p = 0,022) dan volume kehilangan darah selama operasi ≥ 70 mL/kg (RR 1,283, IK 95% 1,009 −1,631, p = 0,042) adalah faktor risiko infeksi bakteri pascatranspantasi hati. Besar post-hoc power dari masing-masing uji hipotesis yang digunakan adalah 5,07−71,50%. Hasil analisis subgrup menunjukkan lama rawat ICU ≥ 20 hari memiliki risiko 2,479 kali lebih besar untuk mengalami infeksi bakteri multi-drug resistance (IK 95% 1,185 – 5,187, p = 0,016). Sebagai kesimpulan, prevalens infeksi bakteri pada anak dalam kurun waktu 0–6 bulan pascatransplantasi hati di RSCM adalah sebesar 84,13%, dengan faktor risiko berupa lama rawat ICU ≥ 20 hari dan volume kehilangan darah selama operasi ≥ 70 mL/kg. Penelitian lanjutan dengan desain lebih baik dan subjek lebih banyak diperlukan.

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Survival rate and quality of life of children with chronic hepatobiliary disease has improved since the development of liver transplantation. Incidence of bacterial infection is 36–79% at 6 months post-transplantation and mortality of 3.0–10.6% at 3 months post-transplantation. Adequate prevention of bacterial infection will reduce morbidity and mortality and increase survival. This study aimed to determine the risk factors for bacterial infection in children who underwent liver transplantation in Indonesia. This retrospective cohort study includes pediatric recipients who underwent liver transplantation in Cipto Mangunkusumo Hospital (CMH) during December 2010 – April 2023 with total sampling method. Subjects were classified into groups with and without bacterial infection. Prevalence of bacterial infection of the 63 subjects was 84.13%. A majority of the bacterial infection cases were hospital-acquired infections (HAIs), comprising of surgical site infections (29.63%), ventilator-associated pneumonia (14.81%), and catheter-related urinary tract infections (13.58%). Multivariate analysis showed ICU length of stay ≥20 days (RR 1.212; CI 95% 1.028 −1.426; p = 0.022) and volume of blood loss volume during surgery ≥70 mL/kg (RR 1.283; CI 95% 1.009 −1.631; p = 0.042) were risk factors risk factors for bacterial infection following liver transplantation. Post-hoc power of each hypothesis test was 5.07−71.50%. Subgroup analysis presented ICU length of stay ≥20 days increased risk of multi-drug resistance bacterial infection by 2.479 times (CI 95% 1.185 – 5.187; p = 0.016). Conclusions, Bacterial infection prevalence at six-months post-liver transplantation of children in CMH was 84.13% with ICU length of stay ≥20 days and volume of blood loss volume during surgery ≥70 mL/kg  as risk factors. Further studies with better design and more participants are needed."

"Kompleksitas operasi transplantasi hati dapat mengakibatkan terjadinya gangguan elektrolit utama tubuh seperti natrium, kalium dan klorida. Ketidakseimbangan elektrolit menyebabkan buruknya prognosis pasien pasca-operasi karena berkaitan dengan kejadian morbiditas seperti gangguan hemodinamik, gangguan neurologis (ensefalopati, kejang, central pontine myelinolysis), dan bahkan kematian. Belum adanya penelitian yang menggambarkan prevalens dan penilaian faktor risiko gangguan elektrolit pada populasi pediatri di Indonesia. Penelitian ini dilakukan untuk melihat prevalens dan menilai faktor risiko terjadinya gangguan elektrolit pada pasien anak pascatransplantasi hati di pusat transplantasi hati Rumah Sakit Cipto Mangunkusumo, Jakarta Indonesia. Studi kohort retrospektif yang dilakukan di pusat transplantasi hati RSCM Jakarta, Indonesia dan melibatkan seluruh pasien anak yang menjalani transplantasi hati pada periode Desember 2010 sampai Desember 2023. Penilaian bivariat dan multivariat dilakukan untuk menilai faktor risiko yang berhubungan dengan gangguan elektolit pascatransplantasi hati. Sebanyak 78 subyek memenuhi kriteria inklusi dengan 79,5% diantaranya mengalami gangguan elektrolit. Indikasi operasi transplantasi  hati terbanyak adalah atresia bilier  (79,5%). Faktor risiko yang berpengaruh terhadap gangguan elektrolit pada pasien anak pasca operasi transplantasi hati adalah durasi operasi lebih dari 12 jam (RR 1,46 IK 95% 1,21-1,54) dan kreatinin serum (RR 0,64 IK 95% 0,27-0,98) dengan nilai p<0,05. Sebagian besar pasien anak yang menjalani operasi transplantasi hari mengalami gangguan elektrolit. Durasi operasi lebih dari 12 jam dan peningkatan nilai kreatinin serum berhubungan dengan kejadian gangguan elektrolit.

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The complexity of liver transplantation surgery can lead to major electrolyte disturbances such as sodium, potassium, and chloride. Electrolyte disturbances can result in poor postoperative patient prognosis due to the association with morbidity events such as hemodynamic disorders, neurological disorders (encephalopathy, seizures, central pontine myelinolysis), and even death. There are no studies that describe the prevalence and risk factors of electrolyte disturbances in the pediatric population in Indonesia.This study was conducted to observe the prevalence and assess the risk factors for electrolyte disturbances in pediatric patients after liver transplantation at the Cipto Mangunkusumo Hospital Liver Transplant Center, Jakarta, Indonesia. Retrospective cohort study conducted at a liver transplant center in Jakarta, Indonesia, involving all pediatric patients who underwent liver transplantation from December 2010 to December 2023. Bivariate and multivariate assessments were performed to evaluate the risk factors associated with post-liver transplantation electrolyte disturbances. A total of 78 subjects met the inclusion criteria, with 79.5% experiencing electrolyte disturbances. The most common indication for liver transplantation surgery was biliary atresia (79.5%). The risk factors affecting electrolyte disturbances in pediatric patients after liver transplantation surgery were operation duration more than 12 hours (RR 1.46, 95% CI 1.21-1.54) and serum creatinine (RR 0.64, 95% CI 0.27-0.98) with a p-value <0.05. Most pediatric patients undergoing liver transplantation experience electrolyte disturbances. An operation duration of more than 12 hours and an increase in serum creatinine levels are associated with the occurrence of electrolyte disturbance."