Determinants of length of stay after pediatric liver transplantation

Abstract

Background:We sought to identify factors that are associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. Methods:We identified 2726 infants (≤24 months) and 3210 children (>24 months) who underwent pediatric liver-only transplantation from 2002-2017 using the Scientific Registry of Transplant Recipients. We used multilevel multivariable negative binomial regression to analyze associations between LOS and recipient and donor characteristics and calculated the MLOSR to quantify heterogeneity in LOS across centers. Results:In infants, the median LOS (IQR) was 19 (13-32) days. Hospitalization prior to transplant (ICU ratio: 1.46 1.59 1.70 ; non-ICU ratio: 1.08 1.16 1.23 ), public insurance (ratio: 1.03 1.09 1.15 ), and a segmental graft (ratio: 1.08 1.15 1.22 ) were associated with a longer LOS; thus, we would expect a 1.59-fold longer LOS in an infant admitted to the ICU compared to a non-hospitalized infant with similar characteristics. In children, the median LOS (IQR) was 13 (9-21) days. Hospitalization prior to transplant (ICU ratio: 1.49 1.62 1.77 ; non-ICU ratio: 1.34 1.44 1.56 ), public insurance (ratio: 1.02 1.07 1.13 ), a segmental graft (ratio: 1.20 1.27 1.35 ), a living donor graft (ratio: 1.27 1.38 1.51 ), and obesity (ratio: 1.03 1.10 1.17 ) were associated with a longer LOS. The MLOSR was 1.25 in infants and 1.26 in children, meaning if an infant received a transplant at another center with a longer LOS, we would expect a 1.25-fold difference in LOS driven by center practices alone. Conclusions:While center-level practices account for substantial variation in LOS, consideration of donor and recipient factors can help clinicians provide more personalized counseling for families of pediatric liver transplant candidates. K E Y W O R D S length of stay, liver transplantation, MELD, pediatric, PELD Approximately 600 children with ESLD will undergo liver transplantation annually in the United States, with priority given to the sickest candidates as determined by the PELD/MELD score. 1 Understanding hospital LOS is necessary to provide more personalized counseling and discharge planning for pediatric liver transplant recipients and their families. 2 From a more practical perspective, understanding LOS is important for families when considering how duration of hospitalization will affect other aspects of their lives, such as arranging childcare for siblings, requesting time off work, and coordinating travel between the transplant center and the patient's home. 3 Most importantly, a prolonged hospitalization places pediatric liver transplant recipient at risk for developing hospital-acquired infections.Finally, from a financial perspective, a longer LOS incurs more costs; a longer LOS in adult liver transplant recipients has been tied to increasing costs and resource utilization. 4A previous multi-center study from the pre-PELD/MELD era of pediatric liver transplantation found that recipients...

Immediate extubation following pediatric liver transplantation

“…Specifically, preoperative mechanical ventilation, pRBC transfusion volume, age < 2 years, dopamine and vasopressin infusion volume, MELD/PELD >30 were all found to be associated with longer ICU or overall hospital length of stay, and all had a lower incidence among patients that were extubated in the OR. Additionally, deceased donor partial liver graft transplantation was associated with longer ICU and overall hospital length of stay, consistent with previous studies on predictors of hospital length of stay following pediatric liver transplantation 13,14 …”

“…Additionally, deceased donor partial liver graft transplantation was associated with longer ICU and overall hospital length of stay, consistent with previous studies on predictors of hospital length of stay following pediatric liver transplantation. 13,14 This study is limited by its retrospective nature, small number of recipients relative to adult liver transplant series, and relatively short follow-up time. Several of the variables in the regression models have wide confidence intervals and therefore should be validated in a larger, ideally multi-institutional series.…”

Factors associated with postoperative respiratory conditions and critical outcomes on pediatric liver transplantation: A single-center experience

“…Younger age and higher proportion of low body weight in our patients were the possible causes. In addition, public insurance was associated with a longer LOS in the hospital in pediatric OLT patients, 18 and people in Taiwan were included in an affordable and accessible national public health insurance, which may be another possible explanation for our longer length of PICU stay.…”

Center variation in long-term outcomes for socioeconomically deprived children

“…There is significant center‐to‐center variation in pediatric liver transplantation protocols and outcomes, including organ offer acceptance patterns, posttransplant length of stay, and likelihood of early graft loss 4‐6 . One of the benefits of the robust reporting requirements in the transplantation field is that these requirements enable us to identify high performing centers.…”

“…AJT acceptance patterns, posttransplant length of stay, and likelihood of early graft loss. [4][5][6] One of the benefits of the robust reporting requirements in the transplantation field is that these requirements enable us to identify high performing centers. Recognizing centers as high performers could prompt national quality improvement efforts to identify best practices.…”