Scoring Systems and Postoperative Outcomes in Pediatric Liver Transplantation

Ferah, Oya; Akbulut, Akın; Açık, Mehmet Eren; Gökkaya, Zafer; Acar, Umut; Yenidünya, Özlem; Yentür, Ercüment; Tokat, Yaman

doi:10.1016/j.transproceed.2019.01.174

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…One potential minor limitation of this approach is that intraoperative fluid administration may have impacted fluid management and clinical decision making postoperatively, and this potential impact was not able to be accounted for. Finally, we adjusted for severity of illness by including PRISM‐III score in our adjusted multivariate analyses, which is a highly validated and commonly used severity of illness score in general PICU populations, but it is possible that other variables may better predict disease severity in pediatric LT recipients 35 …”

Section: Discussionmentioning

confidence: 99%

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Fluid balance in pediatric postoperative liver transplant recipients

Winters

Brocks

Chapin

et al. 2023

Pediatric Transplantation

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Background Positive fluid balance (FB) is associated with poor outcomes in critically ill children but has not been studied in pediatric liver transplant (LT) recipients. Our goal is to investigate the relationship between postoperative FB and outcomes in pediatric LT recipients. Methods We performed a retrospective cohort study of first‐time pediatric LT recipients at a quaternary care children's hospital. Patients were stratified into three groups based on their FB in the first 72 h postoperatively: <10%, 10–20%, and > 20%. Outcomes were pediatric intensive care unit (PICU) and hospital length of stay, ventilator‐free days (VFD) at 28 days, day 3 severe acute kidney injury, and postoperative complications. Multivariate analyses were adjusted for age, preoperative admission status, and Pediatric Risk of Mortality (PRISM)‐III score. Results We included 129 patients with median PRISM‐III score of 9 (interquartile range, IQR 7–15) and calculated Pediatric End‐stage Liver Disease score of 15 (IQR 2–23). A total of 37 patients (28.7%) had 10–20% FB, and 26 (20.2%) had >20% FB. Greater than 20% FB was associated with an increased likelihood of an additional PICU day (adjusted incident rate ratio [aIRR] 1.62, 95% CI: 1.18–2.24), an additional hospital day (aIRR 1.39, 95% CI: 1.10–1.77), and lower likelihood of a VFD at 28 days (aIRR 0.85, 95% CI: 0.74–0.97). There were no differences between groups in the likelihood of postoperative complications. Conclusions In pediatric LT recipients, >20% FB at 72 h postoperatively is associated with increased morbidities, independent of age and severity of illness. Additional studies are needed to explore the impact of fluid management strategies on outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Finally, we adjusted for severity of illness by including PRISM-III score in our adjusted multivariate analyses, which is a highly validated and commonly used severity of illness score in general PICU populations, but it is possible that other variables may better predict disease severity in pediatric LT recipients. 35…”

Section: Discussionmentioning

confidence: 99%

Fluid balance in pediatric postoperative liver transplant recipients

Winters

Brocks

Chapin

et al. 2023

Pediatric Transplantation

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“…The risk scores currently utilized [pediatric end-stage liver disease (PELD), Child-Turcotte-Pugh (CTP), and pediatric risk of mortality (PRISM-III)] were not designed for the purpose of predicting perioperative complications in the pediatric liver transplantation population. 7 Several studies have attempted to determine risk factors for poor outcomes including postoperative mortality, graft loss, 8,9 acute kidney injury, 10,11 prolonged mechanical ventilation, 12 and graft vascular complications. 13 Hospital length of stay (LOS) functions as a surrogate marker of early postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there are no clinical tools that accurately identify at‐risk patients in the early postoperative period in the intensive care unit (ICU). The risk scores currently utilized [pediatric end‐stage liver disease (PELD), Child–Turcotte–Pugh (CTP), and pediatric risk of mortality (PRISM‐III)] were not designed for the purpose of predicting perioperative complications in the pediatric liver transplantation population 7 . Several studies have attempted to determine risk factors for poor outcomes including postoperative mortality, graft loss, 8,9 acute kidney injury, 10,11 prolonged mechanical ventilation, 12 and graft vascular complications 13 .…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a multivariable prediction model in pediatric liver transplant patients for predicting intensive care unit length of stay

Siddiqui

Faraoni

Williams

et al. 2023

Pediatric Anesthesia

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BackgroundLiver transplantation is the life‐saving treatment for many end‐stage pediatric liver diseases. The perioperative course, including surgical and anesthetic factors, have an important influence on the trajectory of this high‐risk population. Given the complexity and variability of the immediate postoperative course, there would be utility in identifying risk factors that allow prediction of adverse outcomes and intensive care unit trajectories.AimsThe aim of this study was to develop and validate a risk prediction model of prolonged intensive care unit length of stay in the pediatric liver transplant population.MethodsThis is a retrospective analysis of consecutive pediatric isolated liver transplant recipients at a single institution between April 1, 2013 and April 30, 2020. All patients under the age of 18 years receiving a liver transplant were included in the study (n = 186). The primary outcome was intensive care unit length of stay greater than 7 days.ResultsRecipient and donor characteristics were used to develop a multivariable logistic regression model. A total of 186 patients were included in the study. Using multivariable logistic regression, we found that age < 12 months (odds ratio 4.02, 95% confidence interval 1.20–13.51, p = .024), metabolic or cholestatic disease (odds ratio 2.66, 95% confidence interval 1.01–7.07, p = .049), 30‐day pretransplant hospital admission (odds ratio 8.59, 95% confidence interval 2.27–32.54, p = .002), intraoperative red blood cells transfusion >40 mL/kg (odds ratio 3.32, 95% confidence interval 1.12–9.81, p = .030), posttransplant return to the operating room (odds ratio 11.45, 95% confidence interval 3.04–43.16, p = .004), and major postoperative respiratory event (odds ratio 32.14, 95% confidence interval 3.00–343.90, p < .001) were associated with prolonged intensive care unit length of stay. The model demonstrates a good discriminative ability with an area under the receiver operative curve of 0.888 (95% confidence interval, 0.824–0.951).ConclusionsWe develop and validate a model to predict prolonged intensive care unit length of stay in pediatric liver transplant patients using risk factors from all phases of the perioperative period.

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Perioperative Management after Liver Transplantation

Shanmugam¹,

Dhawan²

2023

Pediatric Solid Organ Transplantation

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Scoring Systems and Postoperative Outcomes in Pediatric Liver Transplantation

Cited by 5 publications

References 11 publications

Fluid balance in pediatric postoperative liver transplant recipients

Fluid balance in pediatric postoperative liver transplant recipients

Development and validation of a multivariable prediction model in pediatric liver transplant patients for predicting intensive care unit length of stay

Perioperative Management after Liver Transplantation

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