Wagenaar Amy E, Tashiro Jun, Sola Juan E, Ekwenna Obi, Tekin Akin, Perez Eduardo A
Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL, 33136, USA.
Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA.
Pediatr Surg Int. 2016 May;32(5):439-49. doi: 10.1007/s00383-016-3881-6. Epub 2016 Mar 21.
We sought to identify factors associated with increased resource utilization and in-hospital mortality for pediatric liver transplantation (LT).
Kids' Inpatient Database (1997-2009) was used to identify cases of LT in patients <20 years old.
Overall, 2905 cases were identified, with an in-hospital survival of 91 %. LT was performed most frequently in < 5 year olds (61 %), females (51 %), and Caucasians (56 %). LT was performed at urban teaching hospitals (97 %) and facilities with children's units (51 %). Indications included pathologic conditions of the biliary tract (44 %) and inborn errors of metabolism (34 %), though unspecified end stage liver disease was the most common (75 %). Logistic regression found higher mortality in children undergoing LT for malignant conditions (odds ratio: 4.8) and acute hepatic failure (OR 3.4). Cases complicated by renal failure (OR 7.7) and complications of LT (OR 2.7) had higher mortality rates. Resource utilization increased for children with renal failure and those with hemorrhage as a complication of LT, p < 0.05.
Hospital survival is predicted by indication and complications associated with LT. Resource utilization increased with renal failure and complications related to LT. Admission length was sensitive to payer status, hospital characteristics, and UNOS region, whereas total costs were unaffected by payer status or hospital type.
我们试图确定与小儿肝移植（LT）资源利用增加及住院死亡率相关的因素。
利用儿童住院数据库（1997 - 2009年）确定20岁以下患者的肝移植病例。
总体上，共确定了2905例病例，住院生存率为91%。肝移植在5岁以下儿童（61%）、女性（51%）和白种人（56%）中最为常见。肝移植在城市教学医院（97%）和设有儿科病房的机构（51%）进行。适应证包括胆道病理状况（44%）和先天性代谢缺陷（34%），尽管未明确的终末期肝病最为常见（75%）。逻辑回归分析发现，因恶性疾病接受肝移植的儿童死亡率较高（优势比：4.8）以及急性肝衰竭患者（优势比3.4）。合并肾衰竭（优势比7.7）和肝移植并发症（优势比2.7）的病例死亡率更高。肾衰竭患儿以及肝移植并发出血的患儿资源利用增加，p < 0.05。
肝移植的适应证和并发症可预测住院生存率。肾衰竭及肝移植相关并发症会增加资源利用。住院时长对支付方状态、医院特征和器官共享联合网络（UNOS）区域敏感，而总费用不受支付方状态或医院类型的影响。
