Impact of pretransplant growth retardation in pediatric liver transplantation.
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.
Barshes
Neal R
NR
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston TX 77030, USA.
Chang
I-Fen
IF
Karpen
Saul J
SJ
Carter
Beth A
BA
Goss
John A
JA
D000293:Adolescent; D000704:Analysis of Variance; D000886:Anthropometry; D001656:Biliary Atresia / Q000191:economics / Q000601:surgery; D001827:Body Height; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006130:Growth Disorders / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D017114:Liver Failure, Acute / Q000191:economics / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics; D008297:Male; D044342:Malnutrition / Q000191:economics; D009752:Nutritional Status; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome