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Updated: Jul 31, 2026
Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
Reducing Hospital Length of Stay and Hepatic Artery Thrombosis Rates for Children Receiving a Liver Transplant: A
Jack Fennessy1, Gordon Thomas2, Greer Waters1
1Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Insights
Pediatric liver transplant hospital length of stay (LOS) significantly decreased after management changes in 2012. Improvements in surgical techniques and postoperative care, including early extubation, contributed to shorter LOS.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Critical Care Medicine
Background:
- Pediatric liver transplantation is a complex and resource-intensive procedure.
- Management strategies evolve to improve patient outcomes and resource utilization.
- Analyzing changes in care over time is crucial for understanding therapeutic advancements.
Purpose of the Study:
- To identify changes in pediatric liver transplant management between two distinct epochs.
- To analyze the impact of these management changes on hospital length of stay (LOS).
- To determine factors influencing LOS in pediatric liver transplant recipients.
Main Methods:
- Retrospective analysis of 336 pediatric liver transplants (282 children) from 2000-2021.
- Comparison of two epochs: pre-July 2012 and post-July 2012, based on anticoagulation management changes.
- Multivariate regression to identify complications correlating with hospital LOS.
Main Results:
- Hospital LOS decreased from a median of 31.7 days in Epoch 1 to 26.3 days in Epoch 2 (p < 0.001).
- Pediatric Intensive Care Unit (PICU) LOS remained unchanged (Median 7.3 vs. 7.4 days).
- Epoch 2 showed increased split graft use, lower PELD scores, reduced ventilation time, and decreased hepatic artery thrombosis (HAT) rates without increased bleeding.
Conclusions:
- Refined intraoperative and postoperative management significantly reduced hospital LOS in pediatric liver transplantation.
- Emphasis on early extubation and noninvasive ventilation techniques in Epoch 2 contributed to shorter stays.
- Increased utilization of split grafts expanded the donor pool and reduced waitlist times.
Background:
Pediatric liver transplantation is a very resource-intensive therapy. This study aimed to identify the changes made between two epochs of management and analyze their influence on length of stay (LOS).
Methods:
Data from a single center were obtained from the liver transplant and Pediatric Intensive Care Unit (PICU) databases for 336 transplants (282 children) performed between 2000 and 2021. Transplants were analyzed in two epochs, before and after July 2012, representing a change in postoperative anticoagulation management. Differences in graft recipient demographics and perioperative management factors were compared between epochs. Multivariate regression was performed to identify the complications that correlated most strongly with hospital LOS.
Results:
There was a difference in hospital LOS between Epoch 1 (Median = 31.7 days) and Epoch 2 (Median = 26.3 days) (p < 0.001), but not in PICU LOS (E1 Median = 7.3 days, E2 Median = 7.4 days; p = 0.792). Epoch 2 saw increased use of split grafts (60.6% of total), decreased pediatric end-stage liver disease (PELD) score at transplant (Average = 16.7; p < 0.001), decreased invasive ventilation time (Average = 4.48 days; p < 0.001), and decreased hepatic artery thrombosis (HAT) rates (E1 = 14.4%, E2 = 4.3%; p < 0.001) without an associated increase in bleeding rates.
Conclusions:
Hospital LOS has reduced in Epoch 2 due to refinements in intraoperative and postoperative management. There is increased emphasis on early extubation and increased use of noninvasive ventilatory techniques in Epoch 2. Split grafts have effectively expanded our graft donor pool and reduced transplant waitlist times.
