Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Department of Surgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Pediatr Transplant. 2024 Sep;28(6):e14844. doi: 10.1111/petr.14844.
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).
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.
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.
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.
儿科肝移植是一种非常耗费资源的治疗方法。本研究旨在确定两个管理阶段之间的变化，并分析其对住院时间（LOS）的影响。
从 2000 年至 2021 年，从肝移植和儿科重症监护病房（PICU）数据库中获取了一家中心的 336 例移植（282 例儿童）的数据。将移植分为两个阶段进行分析，一个阶段在 2012 年 7 月之前，一个阶段在 2012 年 7 月之后，代表了术后抗凝管理的变化。比较了两个阶段中供体和受体的人口统计学特征和围手术期管理因素的差异。采用多元回归分析确定与 LOS 相关性最强的并发症。
两个阶段的 LOS 存在差异（第一阶段中位数=31.7 天，第二阶段中位数=26.3 天）（p<0.001），但 PICU LOS 无差异（第一阶段中位数=7.3 天，第二阶段中位数=7.4 天；p=0.792）。第二阶段使用了更多的分体移植（占总数的 60.6%），移植时 PELD 评分降低（平均值=16.7；p<0.001），侵入性通气时间缩短（平均值=4.48 天；p<0.001），肝动脉血栓形成（HAT）发生率降低（第一阶段=14.4%，第二阶段=4.3%；p<0.001），而出血率没有增加。
第二阶段由于术中及术后管理的改进，住院时间缩短。第二阶段更强调早期拔管和增加使用无创通气技术。分体移植有效地扩大了我们的供体库，减少了移植等待时间。
