K. Covarrubias1, X. Luo1, D. Mogul2, J. Garonzik-Wang1, D. L. Segev1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Pediatric Gastroenterology & Hepatology,Baltimore, MD, USA
Introduction: Pediatric liver transplantation is a life saving treatment modality for patients and their families that requires extensive multidisciplinary assessment in the pre-transplantation period. In order to better inform medical decision making and discharge planning, and ultimately provide more personalized patient counseling, we sought to identify recipient, donor, and surgical characteristics that influence hospital length of stay (LOS) following pediatric liver transplantation.
Methods: We studied 3956 first time pediatric (<18 yrs old) transplant recipients between 2002 and 2016 using SRTR data. We excluded patients ever listed as status 1A and patients who died prior to discharge. We used multi-level negative binomial regression to estimate incidence rate ratios (IRR) for hospital LOS accounting for center level variation. For recipients <12 yrs old, PELD (Pediatric End-Stage Liver Disease) score was used for analysis and for older transplant recipients, MELD (Model for End-Stage Liver Disease) was used.
Results:The median LOS in our study population was 15 hospital days after transplantation. Our analysis determined that a MELD/PELD score >14 (MELD 15-25: IRR 1..081.141.21, MELD/PELD 25-29:1.271.391.52, MELD/PELD >30: 1.171.281.41,), exception points (1.061.121.18), partial grafts (1.161.231.31), and Hispanic ethnicity (1.001.071.15) were associated with a longer LOS (p<0.05). A graft from a live donor (0.810.880.96), recipient weight greater than 10 kg (10-35 kg: 0.760.800.85, >35 kg: 0.610.660.70), and non-hospitalized patient status (0.710.800.90) were associated with a decreased LOS (p<0.05).
Conclusion: Our findings suggest that the ability to transplant patients at lower MELD/PELD scores and increased use of grafts from living donors would lead to decreased healthcare utilization in the immediate postoperative period. Latino ethnicity and public health insurance were also associated with a longer LOS, however our model does not account for any healthcare disparities faced by such groups of people including socioeconomic status and language barriers.
