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The burden of early hospitalization (within 6 months) following simultaneous liver-kidney transplant (SLKT) is not known. We examined risk factors associated with early hospitalization after SLKT and their impact on patient mortality conditional on 6-month survival. We used data from the US Multicenter SLKT Consortium cohort study of all adult SLKT recipients between 2002 and 2017 who were discharged alive following SLKT. We used Poisson regression to model rates of early hospitalizations after SLKT. Cox regression was used to identify risk factors associated with mortality conditional on survival at 6 months after SLKT. Median age (N = 549) was 57.7 years (interquartile range [IQR], 50.6-63.9) with 63% males and 76% Whites; 33% had hepatitis C virus, 20% had non-alcohol-associated fatty liver disease, 23% alcoholassociated liver disease, and 24% other etiologies. Median body mass index (BMI) and Model for End-Stage Liver Disease-sodium scores were 27.2 kg/ m 2 (IQR, 23.6-32.2 kg/m 2 ) and 28 (IQR, 23-34), respectively. Two-thirds of the cohort had at least one hospitalization within the first 6 months of SLKT.Age, race, hospitalization at SLKT, diabetes mellitus, BMI, and discharge to subacute rehabilitation (SAR) facility after SLKT were independently associated with a high incidence rate ratio of early hospitalization. Number of hospitalizations within the first 6 months did not affect conditional survival. Early hospitalizations after SLKT were very common but did not affect conditional

Objectives/Hypothesis The optimal surgical treatment to improve sleep apnea in children with small tonsils is not known. Drug‐induced sleep endoscopy (DISE) may be useful in selecting effective surgical procedures for this patient population. This study compared polysomnography (PSG) measures before and after DISE‐directed surgery in children with small tonsils. We hypothesize that DISE‐directed surgery improves PSG measures in children with small tonsils. We also aimed to identify the most common surgery performed in this population. Study Design Retrospective chart review. Methods A retrospective review was performed of subjects who underwent DISE at a single pediatric tertiary care center over a 6‐year period. Inclusion criteria were 1+ tonsils and PSG performed before and after DISE‐directed surgery. Exclusion criteria were previous tonsillectomy and tonsils score 2+ or greater. Pre‐ and postoperative PSG parameters were compared using paired t tests. Results Average age was 7 ± 4 years old at the time of surgery. The most common DISE‐directed intervention was supraglottoplasty (n = 23). DISE‐directed surgery significantly improved mean apnea‐hypopnea index (AHI) from 14.4 to 8.0 (P = .02). Although improvements were seen in mean obstructive AHI (12.5 to 5.5), O2 nadir (87.0 to 88.3), and ODI (10.6 to 5.8), these measures did not reach statistical significance. Conclusions DISE‐directed surgery significantly improves AHI in children with small tonsils. The most common intervention performed on these children was supraglottoplasty. Interestingly, adenotonsillectomy was rarely performed in this cohort. Additionally, supraglottic collapse, prompting supraglottoplasty, is difficult to accurately assess in an awake child, supporting use of a DISE‐directed approach in this patient population. Level of Evidence 4 Laryngoscope, 129:2771–2774, 2019

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