C. S. Hwang1,2, M. Mac Conmara1,2, T. Meza2, D. Desai1,2, E. J. Alfrey3 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2Children’s Medical Center,Pediatric Transplantation,Dallas, Tx, USA 3Stanford University,Surgery,Palo Alto, CA, USA
Introduction: Previous studies have examined factors that lead to increased post-operative length of stay (LOS) in the adult liver transplant population. Severity of illness has been shown to increase LOS in this population. We examined how severity of illness at time of transplantation as demonstrated by medical condition at the time of transplant affected overall, pre-transplant and post-transplant length of stay (LOS) in the pediatric liver transplant population at a single center.
Methods: We examined outcome in all pediatric patients who underwent liver transplantation between January 2010 and July 2014. Recipient and donor demographic data, and outcome data were examined. Demographic and outcome data included age, race, sex, weight, blood type, cold storage time (CST, time from donor aortic cross clamp to out of ice) in minutes, anastomotic time in minutes, estimated blood loss (EBL) at transplant, intraoperative transfusion requirement, presence and number of rejections, graft survival, liver disease, total LOS, medical condition at time of transplant (admitted to the intensive care unit (ICU), to the ward, or coming from home), pre-transplant LOS, and post-transplant LOS. Categorical differences were compared using the unpaired Student's t-test and nominal variables using either the Chi Square or the Fischer's exact test. A p-value of <0.05 was considered significant.
Results: Forty-six pediatric patients underwent liver transplantation. The recipient age in months at transplantation was 62.7+/-59.5 months, weight was 20.2+/-15.5 kg, CST was 432+/-98 minutes, anastomotic time was 57+/-17 minutes, EBL was 399+/-501 mL, intraoperative transfusion requirement was 360+/-371 mL, donor age was 89.5+/-115 months, and donor weight was 26.3+/-20.7 kg. The average LOS for all patients was 24.7+/-12.6 days. The mean LOS was 31.7+/-13.8 days, 29.0+/-10.9 days, and 20.2+/-11.2 days in the ICU, ward, and home groups respectively. The average pre-transplant LOS in the ICU, ward, and home groups were 13.3+/-7.8, 14.8+/-11.7, and 0.7+/-0.5 days respectively. The overall LOS and pre-transplant LOS were significantly longer in the ICU and ward groups compared to the home group (p < 0.05 and p < 0.0001, respectively). The post-transplant LOS was 18.5+/-10.5, 14.2+/-4.1, and 19.6+/-11.1 days for the ICU, ward, and home groups (p=NS). There was also no significant difference between the etiology of liver disease and LOS.
Conclusion: Patients who had increased severity of illness had an increased overall length of stay. The length of stay pre-transplant did not differ significantly between the ICU and ward groups. Despite the ICU and ward patients being more ill pre-transplant, this did not translate into a longer post-transplant length of stay.