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Hospitalization in children during the first year after kidney transplantation
G S Arbus1, E K Sullivan, A Tejani
1Department of Paediatrics, Hospital for Sick Children, Toronto, Canada.
Insights
Pediatric kidney transplant recipients had shorter hospital stays with living donors (LD) versus cadaveric donors (CAD). Factors like age, prior dialysis, and race influenced hospitalization length and graft survival in pediatric renal transplant patients.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Immunology
Background:
- Renal transplantation is a critical treatment for pediatric end-stage renal disease.
- Understanding factors influencing hospitalization length is crucial for optimizing patient care and outcomes.
- Previous studies have not comprehensively analyzed hospitalization duration in relation to donor type and patient characteristics in pediatric renal transplant recipients.
Purpose of the Study:
- To investigate the length of hospital stay in pediatric renal transplant recipients.
- To compare hospitalization duration between living donor (LD) and cadaveric donor (CAD) recipients.
- To identify patient and graft-related factors associated with prolonged hospital stays.
Main Methods:
- Retrospective analysis of 2171 North American pediatric patients undergoing renal transplantation.
- Comparison of hospitalization days during the first year post-transplant between LD and CAD recipients.
- Identification of demographic, clinical, and treatment-related variables associated with prolonged hospital stay.
Main Results:
- Patients receiving LD transplants had significantly shorter hospital stays (28.8 days) compared to CAD recipients (36.0 days) in the first year post-transplant.
- Prolonged hospital stays were associated with younger age (<1 year), prophylactic ALG/OKT3 use, and prior dialysis in LD recipients.
- Non-White recipients and those with cold ischemic times >24 hours experienced longer hospitalizations in the CAD group.
- Hospitalization rates were higher in the 2-6 month period post-transplant for both groups (51% LD, 68% CAD) compared to the 7-12 month period (27% LD, 31% CAD).
- Graft loss and rejection episodes were primary reasons for hospitalization.
Conclusions:
- Living donor kidney transplantation is associated with shorter initial hospitalization periods in pediatric patients.
- Specific patient and treatment factors necessitate tailored management strategies to reduce prolonged hospital stays and improve graft survival.
- Further evaluation of clinical practices is warranted to optimize outcomes in pediatric renal transplantation.
Abstract:
Length of hospital stay post-renal transplant was investigated in 2171 North American pediatric patients. Hospitalization for those surviving one year with a functioning graft was 28.8 versus 36.0 days (P < 0.05) for living donor (LD) compared with cadaveric donor (CAD) recipients during the first year post-transplant. Significantly prolonged hospital stays were recorded for LD recipients who (a) were less than one-year-old, (b) were receiving prophylactic ALG/OKT3, and (c) had a history of prior dialysis, and for CAD recipients who (a) were non-White and (b) received kidneys with cold ischemic times over 24 hours. In period II (2 to 6 months post-transplant), 51% and 68% of LD and CAD recipients, respectively were hospitalized while the corresponding values were 27% or 31% in period III (7 to 12 months post-transplant). Hospitalization was due mainly to graft loss or rejection episodes. Prolonged hospital stay coupled with poor graft survival might help to determine which aspects of the clinical practice of transplanting children warrant changes.