Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA.
Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Pediatr Nephrol. 2023 Dec;38(12):4187-4196. doi: 10.1007/s00467-023-06066-x. Epub 2023 Jul 11.
Kidney transplants (KT) are accepted as the kidney replacement therapy of choice for children with kidney failure. The surgery itself may be more difficult especially in small children, and often leads to significant hospital stays. There is little research on predicting prolonged length of stay (LOS) in children. We aim to examine the factors associated with prolonged LOS following pediatric KT to help clinicians make informed decisions, better counsel families, and potentially reduce preventable causes of prolonged stay.
We retrospectively analyzed the United Network for Organ Sharing database for all KT recipients less than 18 years old between January 2014 and July 2022 (n = 3693). Donor and recipient factors were tested in univariate and multivariate logistic analysis using stepwise elimination of non-significant factors to create a final regression model predicting LOS longer than 14 days. Values were assigned to significant factors to create risk scores for each individual patient.
In the final model, only primary diagnosis of focal segmental glomerulosclerosis, dialysis prior to KT, geographic region, and recipient weight prior to KT were significant predictors of LOS longer than 14 days. The C-statistic of the model is 0.7308. The C-statistic of the risk score is 0.7221.
Knowledge of the risk factors affecting prolonged LOS following pediatric KT can help identify patients at risk of increased resource use and potential hospital-acquired complications. Using our index, we identified some of these specific risk factors and created a risk score that can stratify pediatric recipients into low, medium, or high risk groups. A higher resolution version of the Graphical abstract is available as Supplementary information.
肾移植（KT）被认为是肾衰竭儿童的首选肾脏替代疗法。手术本身可能更具挑战性，尤其是对于年幼的儿童，并且通常会导致住院时间延长。关于预测儿童住院时间延长的研究甚少。我们旨在研究与儿童 KT 后住院时间延长相关的因素，以帮助临床医生做出明智的决策，更好地为患者家庭提供建议，并可能减少导致住院时间延长的可预防因素。
我们回顾性分析了 2014 年 1 月至 2022 年 7 月期间年龄小于 18 岁的所有 KT 受者的美国器官共享网络数据库（n=3693）。使用逐步消除无统计学意义的因素的方法，在单变量和多变量逻辑回归分析中对供者和受者因素进行测试，以创建最终预测 LOS 超过 14 天的回归模型。为每个患者分配有统计学意义的因素的分值，以创建风险评分。
在最终模型中，仅原发性局灶节段性肾小球硬化、KT 前透析、地理位置和 KT 前受者体重是 LOS 超过 14 天的显著预测因素。该模型的 C 统计量为 0.7308。风险评分的 C 统计量为 0.7221。
了解影响儿童 KT 后 LOS 延长的危险因素有助于识别有增加资源使用和潜在医院获得性并发症风险的患者。使用我们的指标，我们确定了一些特定的风险因素，并创建了一个风险评分，可以将儿科受者分为低、中或高风险组。更清晰的图表摘要版本可作为补充信息获取。
