Reducing Hospital Length of Stay and Hepatic Artery Thrombosis Rates for Children Receiving a Liver Transplant: A Single‐Center Experience From 2000 to 2021

• Published in: Pediatric transplantation Vol. 28; no. 6; pp. e14844 - n/a
• Main Authors: Fennessy, Jack, Thomas, Gordon, Waters, Greer, Stormon, Michael, Shun, Albert, Cavazzoni, Elena
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.09.2024
• Subjects: Adolescent; Child; Child, Preschool; Female; Hepatic artery; Hepatic Artery - surgery; Humans; Infant; Intensive Care Units, Pediatric; Length of stay; Length of Stay - statistics & numerical data; Liver diseases; Liver Transplantation; Liver transplants; Male; Multivariate Analysis; pediatric intensive care; pediatric liver transplantation; Pediatrics; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Thrombosis; Thrombosis - epidemiology; Thrombosis - etiology; length of stay; pediatric liver transplantation; pediatric intensive care
• ISSN: 1397-3142; 1399-3046; 1399-3046
• DOI: 10.1111/petr.14844

ABSTRACT Background Pediatric liver transplantation is a very resource‐intensive therapy. This study aimed to identify the changes made between two epochs of management and analyze their influence on length of stay (LOS). Methods Data from a single center were obtained from the liver transplant and Pediatric Intensive Care Unit (PICU) databases for 336 transplants (282 children) performed between 2000 and 2021. Transplants were analyzed in two epochs, before and after July 2012, representing a change in postoperative anticoagulation management. Differences in graft recipient demographics and perioperative management factors were compared between epochs. Multivariate regression was performed to identify the complications that correlated most strongly with hospital LOS. Results There was a difference in hospital LOS between Epoch 1 (Median = 31.7 days) and Epoch 2 (Median = 26.3 days) (p < 0.001), but not in PICU LOS (E1 Median = 7.3 days, E2 Median = 7.4 days; p = 0.792). Epoch 2 saw increased use of split grafts (60.6% of total), decreased pediatric end‐stage liver disease (PELD) score at transplant (Average = 16.7; p < 0.001), decreased invasive ventilation time (Average = 4.48 days; p < 0.001), and decreased hepatic artery thrombosis (HAT) rates (E1 = 14.4%, E2 = 4.3%; p < 0.001) without an associated increase in bleeding rates. Conclusions Hospital LOS has reduced in Epoch 2 due to refinements in intraoperative and postoperative management. There is increased emphasis on early extubation and increased use of noninvasive ventilatory techniques in Epoch 2. Split grafts have effectively expanded our graft donor pool and reduced transplant waitlist times. A new anticoagulation protocol has helped reduce hepatic artery thrombosis rates and hospital length of stay in pediatric liver transplant recipients. To achieve better outcomes, recent emphasis has been placed on early extubation, and increased use of split liver grafts, which has successfully expanded the donor pool.