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Determinants of length of stay after pediatric liver transplantation

Karina Covarrubias1, Xun Luo1, Allan Massie1,2

  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pediatric Transplantation
|March 27, 2020
PubMed

Insights

Factors like pre-transplant hospitalization and public insurance are linked to longer hospital stays after pediatric liver transplants. Understanding these can improve patient counseling and discharge planning for families.

Area of Science:

  • Pediatric Hepatology
  • Transplant Surgery
  • Health Services Research

Background:

  • Pediatric liver transplantation involves complex care pathways.
  • Length of stay (LOS) after transplantation impacts resource utilization and family burden.
  • Identifying factors influencing LOS is crucial for optimizing care and planning.

Purpose of the Study:

  • To identify recipient and donor characteristics associated with length of stay (LOS) after pediatric liver transplantation.
  • To quantify the heterogeneity in LOS across transplant centers.

Main Methods:

  • Analysis of 2726 infants and 3210 children undergoing liver-only transplantation (2002-2017) from the Scientific Registry of Transplant Recipients.
  • Utilized multilevel multivariable negative binomial regression to assess factors associated with LOS.
  • Calculated the Multicenter Length of Stay Ratio (MLOSR) to measure center-level variation.

Main Results:

  • Infants: Median LOS 19 days. Factors increasing LOS include pre-transplant hospitalization (ICU: 1.59x, non-ICU: 1.16x), public insurance (1.09x), and segmental grafts (1.15x).
  • Children: Median LOS 13 days. Factors increasing LOS include pre-transplant hospitalization (ICU: 1.62x, non-ICU: 1.44x), public insurance (1.07x), segmental grafts (1.27x), living donor grafts (1.38x), and obesity (1.10x).
  • Center practices accounted for significant variation (MLOSR: 1.25 in infants, 1.26 in children).

Conclusions:

  • Recipient factors such as pre-transplant hospitalization, insurance status, and graft type significantly influence LOS in pediatric liver transplantation.
  • While center-level practices contribute to LOS variation, understanding individual patient factors is key.
  • Personalized counseling and discharge planning can be enhanced by considering these identified factors for pediatric liver transplant recipients and their families.
Abstract

Keywords:
MELDPELDlength of stayliver transplantationpediatric

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