Determinants of length of stay after pediatric liver transplantation

Background We sought to identify factors that are associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. Methods We identified 2726 infants (<= 24 months) and 3210 children (>24 months) who underwent pediatric liver-only transplantation from 2002-2017 using the Scientific Registry of Transplant Recipients. We used multilevel multivariable negative binomial regression to analyze associations between LOS and recipient and donor characteristics and calculated the MLOSR to quantify heterogeneity in LOS across centers. Results In infants, the median LOS (IQR) was 19 (13-32) days. Hospitalization prior to transplant (ICU ratio:(1.46)1.59(1.70); non-ICU ratio:(1.08)1.16(1.23)), public insurance (ratio:(1.03)1.09(1.15)), and a segmental graft (ratio:(1.08)1.15(1.22)) were associated with a longer LOS; thus, we would expect a 1.59-fold longer LOS in an infant admitted to the ICU compared to a non-hospitalized infant with similar characteristics. In children, the median LOS (IQR) was 13 (9-21) days. Hospitalization prior to transplant (ICU ratio:(1.49)1.62(1.77); non-ICU ratio:(1.34)1.44(1.56)), public insurance (ratio:(1.02)1.07(1.13)), a segmental graft (ratio:(1.20)1.27(1.35)), a living donor graft (ratio:(1.27)1.38(1.51)), and obesity (ratio:(1.03)1.10(1.17)) were associated with a longer LOS. The MLOSR was 1.25 in infants and 1.26 in children, meaning if an infant received a transplant at another center with a longer LOS, we would expect a 1.25-fold difference in LOS driven by center practices alone. Conclusions While center-level practices account for substantial variation in LOS, consideration of donor and recipient factors can help clinicians provide more personalized counseling for families of pediatric liver transplant candidates.