Impact of pretransplant growth retardation in pediatric liver transplantation.

Abstract

OBJECTIVE:

Malnutrition frequently complicates end-stage liver disease and orthotopic liver transplantation (OLT) in pediatric patients. Pretransplant malnutrition has been associated with increased post-OLT mortality and length of stay in adults. The relationship between pre-OLT nutritional status and post-OLT outcomes in pediatric liver transplant recipients, however, is not well studied.

METHODS:

The records of 65 pediatric patients who underwent OLT at a single institution were reviewed. Univariate analyses were used to investigate the relationship between anthropomorphic data (expressed as z-scores) and post-OLT hospital length-of-stay, hospital costs and clinical outcomes. A multivariate model was then used to identify peri-OLT variables independently correlated with post-OLT length-of-stay.

RESULTS:

A decreased height z-score was correlated with an increased post-OLT hospital length-of-stay (r = -0.30; P = 0.015) and increased hospital costs (r = -0.49; P = 0.0004). The mean length-of-stay was 20.5 days for patients with a height z-score of <-1.5 and 10.7 days for patients with a height z-score of >1.5 (P = 0.038). Likewise, hospital costs were about $40,000 higher (25% increased) for patients with growth retardation. A weak direct correlation was seen between weight z-score and post-OLT length-of-stay (r = 0.18; P = 0.15). Height z-score, biliary atresia and pre-OLT protime were independently and significantly correlated with post-OLT length-of-stay in a multivariate model.

CONCLUSIONS:

Height z-score is a better indicator of pretransplant malnutrition than weight z-score. Pretransplant growth retardation is associated with increased post-OLT hospital length-of-stay and increased hospitalization costs.

• Authors: Neal R Barshes, I-Fen Chang, Saul J Karpen, Beth A Carter, John A Goss
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 43 Issue 1 Pg. 89-94 (Jul 2006) ISSN: 0277-2116 [Print] United States
• PMID: 16819383 (Publication Type: Journal Article)

Topics

• Adolescent
• Analysis of Variance
• Anthropometry
• Biliary Atresia (economics, surgery)
• Body Height
• Body Weight
• Child
• Child, Preschool
• Female
• Graft Survival
• Growth Disorders (economics)
• Hospital Costs
• Humans
• Infant
• Length of Stay (economics)
• Liver Failure, Acute (economics, surgery)
• Liver Transplantation (economics)
• Male
• Malnutrition (economics)
• Nutritional Status
• Survival Analysis
• Texas (epidemiology)
• Treatment Outcome