E. L. Godfrey1, E. T. Pan1, D. Yoeli3, A. Rana2 1Baylor College Of Medicine,Houston, TX, USA 2Baylor College Of Medicine,Division Of Abdominal Transplantation,Houston, TX, USA 3University Of Colorado Denver,Department Of Surgery,Aurora, CO, USA
Introduction:
Factors influencing graft and patient survival in pediatric kidney transplant recipients have been studied, but the outcome of length of stay has rarely been examined, despite its usefulness as a marker of perioperative morbidity. Examining changing predictors of length of stay provides both tools for clinical decision making as well as an assessment of the impact of the current kidney allocation system (KAS); the KAS was introduced in 2014 with a specific focus on reducing ethnic and regional disparities associated with the previous Share 35 system.
Methods:
The United Network for Organ Sharing provided de-identified data on 5,111 patients under the age of 18 listed for kidney transplant from 2005 to 2017, under both the Share 35 and Kidney Allocation System. Age, race, insurance status, a diagnosis of FSGS, KDPI, listing status (active, urgent, or critical), dialysis use and glomerular filtration rate (GFR) at transplant, donation after cardiac death, BMI, regional or national share status, whether the donor organ was on a pump, and cold ischemia time thresholds were all assessed against a length of stay greater than 7 days, 10 days, and 14 days. Univariate regression was performed to identify potential predictors, and multivariate regression was performed to determine which factors were independent predictors of prolonged stay.
Results:
Predictors of prolonged stay have changed between the two allocation systems. Younger age at time of transplant is a predictor of longer stays across all groups. Under the Share 35 system, Hispanic race is a predictor of shorter stays, but being non-Hispanic and non-white is a predictor of longer stays. Being on dialysis before transplant and having a lower GFR are also associated with stays longer than 10 days. In the KAS, increased BMI is also associated with shorter stays, excluding overweight or obese status, which did not have a significant relationship with length of stay. Lower GFR remained a predictor of prolonged stay in general, while either public or private insurance coverage and dialysis before transplant were predictive of stays over 10 days.
Conclusion:
Characteristics indicating poorer native kidney function prior to transplant have been, and remain, predictors of prolonged post-transplant hospitalization. Older age and higher BMI predict shorter hospital course; studies have suggested long-term graft and patient survival are superior in younger recipients, but this effect may only start to be observed longer after transplant: further investigation is needed to reconcile these apparently contradictory findings. The change in race as a predictive factor between Share 35 and KAS corroborates recent studies reporting that transplant rates have increased for non-white recipients, and suggests that this increased access may reduce racial differences in perioperative outcomes. Further study of how the KAS accomplishes this should be utilized to create more equitable future allocation systems.