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.