评价肝移植患儿术前营养状况，并探讨其与术后早期恢复进程及早期临床结局的相关性，为实施围手术期精准营养干预提供依据。

采用前瞻性研究方法，收集2023年1月至2025年8月浙江大学医学院附属第一医院309例行肝移植手术的患儿资料。依据《7岁以下儿童生长标准》评价术前营养状况，分为营养不良组(n＝197)和营养良好组(n＝112)；根据术后ICU停留时间分为≤5 d组(n＝152)和>5 d组(n＝157)。比较营养良好组与营养不良组术后第7天血液学检测指标以及术后首次进食时间、ICU停留时间等早期预后指标。正态分布计量资料组间比较采用成组t检验，非正态分布计量资料组间比较用Mann-Whitney U检验；采用Spearman等级相关分析术前营养状况评分与术后早期临床指标的关系，根据ICU停留时间是否>5 d进行分层分析。P<0.05为差异有统计学意义。

309例肝移植患儿术前营养不良发生率为63.8%(197/309)。营养良好组患儿术后首次进食时间[6.0(5.0，10.0)d]早于营养不良组[7.0(6.0，11.0)d]，营养良好组患儿术后第7天ALT、AST和γ-谷氨酰转移酶(GGT)[128.0 (79.5，229.5)、55.5 (36.0，89.0)和137.5 (76.3，231.8) U/L]均高于营养不良组[110.0 (60.0，174.0)、46.0 (30.0，77.0)和104.0 (65.0，167.0) U/L]，白细胞计数和淋巴细胞计数[9.7 (6.5，14.4)×10⁹/L和3.1 (1.6，5.5)×10⁹/L]均低于营养不良组[11.1 (7.9, 14.7)×10⁹/L和4.0 (2.4，6.7)×10⁹/L]，差异均有统计学意义(Z＝5.592、5.503、4.181、8.792、4.086和4.696，P均<0.05)。肝移植患儿术前营养状况评分与术后首次进食时间、术后第7天淋巴细胞计数和白细胞计数均呈负相关(r＝－0.135、－0.123和－0.115，P均<0.05)，与术后第7天ALT、AST和GGT水平均呈正相关(r＝0.134、0.117和0.169，P均<0.05)。ICU停留时间≤5 d组肝移植患儿术前营养状况评分与呼吸机使用时间和术后首次进食时间均呈负相关(r＝－0.192和－0.149，P均<0.05)，与术后GGT水平呈正相关(r＝0.198，P<0.05)，ICU停留时间>5 d组患儿术前营养状况评分与术后第7天淋巴细胞计数和白细胞计数均呈负相关(r＝－0.216和－0.195，P均<0.05)，与术后GGT水平呈正相关(r＝0.171，P<0.05)。

肝移植患儿术前营养不良发生率较高，且与术后胃肠功能恢复延迟、炎症反应增强及肝功能指标变化密切相关。短时间ICU停留患儿术前营养状况良好可加速呼吸功能恢复；而对于长时间ICU停留患儿，营养不良会显著影响术后免疫调节进程。

To evaluate the preoperative nutritional status of pediatric liver transplant recipients, explore its correlations with early postoperative recovery course and short-term clinical outcomes, and provide empirical evidence for targeted precise perioperative nutritional intervention.

A prospective study was performed. Clinical data of 309 children who underwent liver transplantation at the First Affiliated Hospital, Zhejiang University School of Medicine between January 2023 and August 2025 were collected. Preoperative nutritional status was assessed according to the Growth Standards for Children Under 7 Years Old. Patients were divided into a malnutrition group (n=197) and a well-nourished group (n=112). In addition, all subjects were stratified into two groups based on postoperative ICU stay duration: ≤5 days group (n=152) and >5 days group (n=157). Early prognostic indicators, including time to first postoperative feeding and length of ICU stay, as well as hematological parameters on postoperative day 7, were compared between the two nutritional groups. The t-test was used for intergroup comparison of normally distributed measurement data, the Mann-Whitney U test was applied for non-normally distributed measurement data. Spearman′s rank correlation analysis was conducted to analyze the correlations between preoperative nutritional status scores and early postoperative clinical indicators, and stratified analyses were performed based on whether ICU stay exceeded 5 days. P<0.05 was defined as statistically significant.

The incidence of preoperative malnutrition among the 309 pediatric liver transplant recipients was 63.8% (197/309). Median time to first postoperative feeding was significantly shorter in the well-nourished group [6.0 (5.0, 10.0) days] than that in the malnutrition group [7.0 (6.0, 11.0) days]. On postoperative day 7, the well-nourished group had higher ALT, AST and gamma-glutamyltransferase (GGT) levels [128.0 (79.5, 229.5), 55.5 (36.0, 89.0), 137.5 (76.3, 231.8) U/L] compared with the malnutrition group [110.0 (60.0, 174.0), 46.0 (30.0, 77.0), 104.0 (65.0, 167.0) U/L]. By contrast, white blood cell count and lymphocyte count were lower in the well-nourished group [9.7 (6.5, 14.4)×10⁹/L, 3.1 (1.6, 5.5)×10⁹/L] versus the malnutrition group [11.1 (7.9, 14.7)×10⁹/L, 4.0 (2.4, 6.7) ×10⁹/L]. All intergroup differences were statistically significant (Z=5.592, 5.503, 4.181, 8.792, 4.086, 4.696; all P<0.05). Preoperative nutritional status scores were negatively correlated with time to first postoperative feeding, early postoperative lymphocyte count and white blood cell count (r=-0.135, -0.123, -0.115; all P<0.05), and positively correlated with early postoperative ALT (r=0.134), AST (r=0.117) and GGT (r=0.169) levels (all P< 0.05). Stratified analyses demonstrated that in children with ICU stay ≤5 days, preoperative nutritional status scores were negatively correlated with duration of mechanical ventilation and time to first postoperative feeding (r=-0.192, -0.149; all P<0.05), and positively correlated with postoperative GGT levels (r=0.198; P<0.05). Among patients with ICU stay >5 days, preoperative nutritional status scores were negatively correlated with early postoperative lymphocyte count and white blood cell count (r=-0.216, -0.195; all P<0.05), and positively correlated with postoperative GGT levels (r=0.171; P<0.05).

Preoperative malnutrition is highly prevalent in pediatric liver transplant recipients, and it is closely associated with delayed recovery of postoperative gastrointestinal function, inflammatory response aggravation and changes in liver function parameters. The favorable preoperative nutritional status facilitates the recovery of respiratory function in children with short ICU hospitalization; whereas malnutrition significantly impairs postoperative immune regulation in patients requiring prolonged ICU stay.