TY - JOUR
T1 - Determinants of length of stay after pediatric liver transplantation
AU - Covarrubias, Karina
AU - Luo, Xun
AU - Massie, Allan
AU - Schwarz, Kathleen B.
AU - Garonzik-Wang, Jacqueline
AU - Segev, Dorry L.
AU - Mogul, Douglas B.
N1 - Funding Information:
Dr Covarrubias is supported by a Doris Duke Clinical Research Mentorship Grant. Dr Massie is supported by grant number K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr Garonzik-Wang is supported by grant number K23DK115908 from the NIDDK and a Doris Duke Clinical Scientist Development Award. Dr Segev is supported by grant number K24DK101828 and R01DK111233 from the NIDDK. Dr Mogul is supported by grant number K08HS023876 from the Agency for Healthcare Research and Quality. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of, or interpretation by, the SRTR or the US Government.
Publisher Copyright:
© 2020 Wiley Periodicals, Inc.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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:1.461.591.70; non-ICU ratio:1.081.161.23), public insurance (ratio:1.031.091.15), and a segmental graft (ratio:1.081.151.22) 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:1.491.621.77; non-ICU ratio:1.341.441.56), public insurance (ratio:1.021.071.13), a segmental graft (ratio:1.201.271.35), a living donor graft (ratio:1.271.381.51), and obesity (ratio:1.031.101.17) 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.
AB - 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:1.461.591.70; non-ICU ratio:1.081.161.23), public insurance (ratio:1.031.091.15), and a segmental graft (ratio:1.081.151.22) 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:1.491.621.77; non-ICU ratio:1.341.441.56), public insurance (ratio:1.021.071.13), a segmental graft (ratio:1.201.271.35), a living donor graft (ratio:1.271.381.51), and obesity (ratio:1.031.101.17) 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.
KW - MELD
KW - PELD
KW - length of stay
KW - liver transplantation
KW - pediatric
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U2 - 10.1111/petr.13702
DO - 10.1111/petr.13702
M3 - Article
C2 - 32212292
AN - SCOPUS:85082194368
SN - 1397-3142
VL - 24
JO - Pediatric transplantation
JF - Pediatric transplantation
IS - 4
M1 - e13702
ER -