Pediatric length‐of‐stay index following liver transplantation

Zhang, Theodore; Barrett, Spencer; Cotton, Ronald T.; Galván, Nhu Thao Nguyen; O’Mahony, Christine A.; Vierling, John M.; Goss, John A.; Rana, Abbas

doi:10.1111/petr.13779

Cited by 5 publications

(16 citation statements)

References 20 publications

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“…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 …”

Section: Discussionsupporting

confidence: 88%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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Immediate extubation following pediatric liver transplantation

Yoeli

Nguyen

Wilder

et al. 2022

Pediatric Transplantation

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Background Immediate extubation (IE) following pediatric liver transplantation is being increasingly performed. The aim of this study was to characterize the rate of IE at our institution and identify recipient factors predictive of IE. Methods All pediatric liver transplants performed at our institution between January 1, 2015 and December 31, 2020 were reviewed. Retransplants and multi‐organ transplants were excluded. IE was defined as extubation in the operating room following transplant. Backward stepwise logistic regression at a p‐value threshold of .05 was performed to identify variables associated with IE. Results IE was achieved in 58 (72%) of the 81 pediatric liver transplants. The IE cohort had significantly shorter ICU length of stay and overall hospital length of stay, though IE was not an independent predictor of posttransplant length of stay. Age <2 years, preoperative mechanical ventilation, and total intraoperative epinephrine and dopamine infusion requirements were significant, independent risk factors against IE. This multivariable model was highly predictive of IE (area under the curve = 0.89). Conclusions We describe the highest rate of IE postpediatric liver transplantation that has been reported to date and identified significant risk factors against successful IE.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Immediate extubation following pediatric liver transplantation

Yoeli

Nguyen

Wilder

et al. 2022

Pediatric Transplantation

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“…Recipient age was associated such that for every 1‐year increase in age, hospital length of stay decreased by 0.6 days. This agrees with study findings by Zhang et al, where recipient age less than 2 was associated with a higher odds of hospital length of stay over 30 days 16 . We also found pretransplant mechanical ventilation was associated with an increased hospital stay by more than 14 days.…”

Section: Discussionsupporting

confidence: 93%

“…We also found pretransplant mechanical ventilation was associated with an increased hospital stay by more than 14 days. In contrast, while Zhang et al found pretransplant ICU status and life support was associated with increased hospital length of stay, they did not find that pretransplant mechanical ventilation was associated 16 . In another study of post liver transplant hospital length of stay in children, Covarrubias et al found pretransplant ICU admission was associated with longer length of stay, but they did not measure the impact of pretransplant mechanical ventilation 17 .…”

Section: Discussionmentioning

confidence: 95%

Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A multicenter analysis

Efune

Hoyt

Saynhalath

et al. 2023

Pediatric Anesthesia

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Introduction Fluid administration is an important aspect of the management of children undergoing liver transplantation and may impact postoperative outcomes. Our aim was to evaluate the association between volume of intraoperative fluid administration and our primary outcome, the duration of postoperative mechanical ventilation following pediatric liver transplantation. Secondary outcomes included intensive care unit length of stay and hospital length of stay. Methods We conducted a multicenter, retrospective cohort study using electronic data from three major pediatric liver transplant centers. Intraoperative fluid administration was indexed to weight and duration of anesthesia. Univariate and stepwise linear regression analyses were conducted. Results Among 286 successful pediatric liver transplants, the median duration of postoperative mechanical ventilation was 10.8 h (IQR 0.0, 35.4), the median intensive care unit length of stay was 4.3 days (IQR 2.7, 6.8), and the median hospital length of stay was 13.6 days (9.8, 21.1). Univariate linear regression showed a weak correlation between intraoperative fluids and duration of ventilation (r2 = .037, p = .001). Following stepwise linear regression, intraoperative fluid administration remained weakly correlated (r2 = .161, p = .04) with duration of postoperative ventilation. The following variables were also independently correlated with duration of ventilation: center (Riley Children's Health versus Children's Health Dallas, p = .001), and open abdominal incision after transplant (p = .001). Discussion The amount of intraoperative fluid administration is correlated with duration of postoperative mechanical ventilation in children undergoing liver transplantation, however, it does not seem to be a strong factor. Conclusions Other modifiable factors should be sought which may lead to improved postoperative outcomes in this highly vulnerable patient population.

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“…Specifcally, hepatoblastoma was associated with the highest intent-to-treat (HR: 3.73), waitlist (HR: 6.43), and posttransplant (HR: 3.77) out of the selected indications. Te pediatric end-stage liver disease (PELD) scoring system was implemented in 2002 and designed to equitably distribute organs for transplant based on the risk of 90-day pretransplant death [3,9,[11][12][13]. Currently, the PELD system combines a series of measurable, objective criteria, including serum bilirubin, creatinine, and INR, to calculate a numerical score that can be used to assign priority for transplant.…”

Section: Discussionmentioning

confidence: 99%

Disparate Intent-to-Treat Outcomes for Pediatric Liver Transplantation Based on Indication

Lang

Goff

Montgomery

et al. 2023

Canadian Journal of Gastroenterology and Hepatology

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Background. The impact of indication for pediatric liver transplantation on waitlist and post-transplant mortality outcomes is well known, but the impact on intent-to-treat outcomes has not been investigated. Intent-to-treat survival analysis is important in this study because it is more comprehensive, combining the transplant outcomes of waitlist mortality, post-transplant mortality, and transplant rate into a single metric to elucidate any disparities in outcomes based on indication. Methods. Cox regression was used to analyze factors impacting survival in 8,002 children listed for liver transplant in the UNOS database between 2006 and 2016. The Kaplan–Meier method and log-rank test were used to assess differences in waitlist, post-transplant, and intent-to-treat mortality among the top 5 indications of biliary atresia, acute hepatic necrosis, metabolic disorders, hepatoblastoma, and autoimmune cirrhosis. Results. When compared to the reference group of biliary atresia, multivariate analyses showed that every indication was associated with inferior intent-to-treat outcomes except for metabolic disorders. Hepatoblastoma (hazard ratio (HR): 3.73), autoimmune cirrhosis (HR: 1.86), and AHN (HR: 1.77) were associated with significantly increased intent-to-treat mortality. Hepatoblastoma was also associated with increased post-transplant mortality (HR: 3.77) and was the only indication significantly associated with increased waitlist mortality (HR: 6.43). Conclusion. Significant disparity exists across all indications with respect to an increased intent-to-treat mortality, along with an increased post-transplant and waitlist mortality, when compared to the biliary atresia reference group. If further studies validate these findings, a reexamination of the equitable distribution of allografts for transplant may be warranted as well as a focus on disparities in survival after transplant.

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Pediatric length‐of‐stay index following liver transplantation

Cited by 5 publications

References 20 publications

Immediate extubation following pediatric liver transplantation

Immediate extubation following pediatric liver transplantation

Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A multicenter analysis

Disparate Intent-to-Treat Outcomes for Pediatric Liver Transplantation Based on Indication

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