Summary

Background: Hypomagnesaemia is a frequent complication after liver transplantation (LTx) however;
magnesium is not routinely replaced in the perioperative period.

Material/Methods: The incidence of hypomagnesaemia before and after pediatric LTx was studied in
673 pediatric patients who underwent living-donor liver transplantation (LDLT).

Results: The mean serum Mg levels before LTx was normal, 2.03±0.28 mg/dl, exhibited marked
decrease on 5th postoperative (PO) day, 1.79±0.45, p<0.001, comparing with the pretransplant
value. It reached its nadir in the 1st PO month, p<0.001. Up to the 5th PO
year, serum Mg did not achieve the lower limit of normal, 1.77±0.24, p<0.001 and
incidence of hypomagnesaemia was 60.7% (242/399). Univariate analyses of variables
that can predict graft loss and patient death after LDLT demonstrated that recipient
factors, pre and post transplant serum Mg and blood product transfusions
were potentially risk factors significantly affected the outcome. Multivariate analysis
of potential risk factors showed that pre transplant serum Mg <1.8 mg/dl, (Hazard
ratio (HR) 2.362 [confidence interval (CI) 1.350–4.133]; p=0.003) and pre transplant
BUN, (HR 1.046 [CI 1.014–1.079]; p=0.005) were independent predictors of
graft loss and patient death.

Conclusions: hypomagnesaemia is common before and after pediatric LDLT. Pre transplant hypomagnesaemia
and high BUN are independent risk factors for graft loss or patient
death. Pre transplant hypomagnesaemia patients exhibited decreased survival of their
graft. Post transplant hypomagnesaemia was a potentially risk factor for graft loss.