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1/4 of Pediatric Liver Transplant Recipients Experience Early Hospital Readmission

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Factors associated with 30-day readmission were shorter hospital stays after transplant, insurance status, and patient history of diabetes and malignancy.

New research suggests 23% of first-time pediatric liver transplant recipients are readmitted to the hospital within 30 days of discharge after transplant hospitalization.1

Leveraging data from the Society of Pediatric Liver Transplantation (SPLIT) database, the study identified shorter hospital stays following transplantation, insurance status, and the recipient's history of diabetes or malignancy as factors associated with early hospital readmission (EHR).1

“Although EHR in adult transplant recipients is associated with increased morbidity, mortality, and healthcare cost, the current incidence of and risk factors for EHR following pediatric liver transplantation remain unclear,” Matthew Price, MD, MPH, a general surgery resident at Johns Hopkins Hospital, and colleagues wrote.1 “Given the extensive posttransplant monitoring required by pediatric recipients, understanding the risk factors for EHR is crucial for optimizing patient-centric care.”

According to the Organ Procurement and Transplantation Network, more than 100,000 men, women, and children are currently on the national transplant waitlist. As of September 2024, more than 9000 of those on the waitlist were seeking a liver transplant.2 In adult liver transplant recipients, the incidence of EHR following transplantation is estimated to be 30%-51%, but research about pediatric EHR is sparse.1

To assess the incidence of and risk factors for EHR in pediatric liver transplant recipients, investigators retrospectively examined data from the SPLIT database for first-time liver-only recipients ≤ 18 years of age who were transplanted between January 2011 and March 2022. Those who died or required transplant prior to discharge were excluded, as were those who died or were lost to follow-up within 30 days of discharge without experiencing readmission and those who had a documented readmission in the database but no documented hospital discharge date or readmission date.1

The final cohort included 2808 pediatric liver transplant recipients with a median length of transplantation hospital stay of 15 days (interquartile range [IQR], 11–24). Of these patients, 642 (23%) experienced ≥ 1 EHR, defined as readmission within 30 days of discharge, with the most common reasons being infection (35%), abnormal liver tests (23%), concern for rejection (14%), and dehydration or electrolyte imbalances (14%).1

Upon analysis, diabetes (adjusted relative risk [aRR], 2.33; 95% CI, 1.41–3.86; P = .001) and history of malignancy (aRR, 1.59; 95% CI, 1.19–2.11; P = .002) were independent risk factors for EHR. Investigators pointed out shorter length of transplant hospitalization was also linked to a decreased risk of EHR, as was insurance type, with those with primary insurance of Medicaid or Medicare (aRR, 2.32; 95% CI, 1.34–4.03; P = .003) and those with private insurance (aRR, 2.25; 95% CI, 1.30–3.87; P = .004) having twice the risk of experiencing EHR compared to those with Provincial Government of Canada Insurance.1

The median hospital length of stay was 8 (IQR, 7–9) days for the shortest quartile and 34 (IQR, 28-48) days for the longest quartile. Investigators pointed out recipients in the shortest quartile had a ninefold risk of EHR compared with recipients in the longest quartile (aRR, 8.86; 95% CI, 5.68–13.81; P <.001).1

Of note, the incidence of EHR did not vary by transplant center and was not associated with recipient race; sex; primary diagnosis; weight at transplant < 10 kg; dialysis requirement at the time of transplant; or type of transplant.1

“We found that 23% of pediatric liver transplant recipients experienced EHR after their transplant hospitalization. However, EHR was not associated with differences in one-year survival, suggesting it may be a necessary part of posttransplant care and not an indicator of negative downstream sequelae,” investigators concluded.1 “The main risk factors we identified for EHR were shorter hospital lengths of stay and a history of diabetes or malignancy, all of which should be considered when counseling patients and families and setting expectations regarding post-discharge care.”

References

  1. Price MD, Ruck JM, Dilwali N, et al. Early Hospital Readmission After Pediatric Liver Transplant: A Retrospective Analysis of the Society of Pediatric Liver Transplantation (SPLIT) Database. Pediatric Transplantation. https://doi.org/10.1111/petr.14885
  2. Health Resources and Services Administration. Organ Donation Statistics. October 2024. Accessed January 23, 2025. https://www.organdonor.gov/learn/organ-donation-statistics

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