title: Pediatric liver transplantation: predictors of survival and resource utilization.
abstract: OBJECTIVE
  We sought to identify factors associated with increased resource utilization and in-hospital mortality for pediatric liver transplantation (LT).
  
  
  METHODS
  Kids' Inpatient Database (1997-2009) was used to identify cases of LT in patients <20 years old.
  
  
  RESULTS
  Overall, 2905 cases were identified, with an in-hospital survival of 91 %. LT was performed most frequently in < 5 year olds (61 %), females (51 %), and Caucasians (56 %). LT was performed at urban teaching hospitals (97 %) and facilities with children's units (51 %). Indications included pathologic conditions of the biliary tract (44 %) and inborn errors of metabolism (34 %), though unspecified end stage liver disease was the most common (75 %). Logistic regression found higher mortality in children undergoing LT for malignant conditions (odds ratio: 4.8) and acute hepatic failure (OR 3.4). Cases complicated by renal failure (OR 7.7) and complications of LT (OR 2.7) had higher mortality rates. Resource utilization increased for children with renal failure and those with hemorrhage as a complication of LT, p < 0.05.
  
  
  CONCLUSIONS
  Hospital survival is predicted by indication and complications associated with LT. Resource utilization increased with renal failure and complications related to LT. Admission length was sensitive to payer status, hospital characteristics, and UNOS region, whereas total costs were unaffected by payer status or hospital type.
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL, 33136, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagenaar
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL, 33136, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL, 33136, USA.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
authors.affiliation: Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: Obi
authors.initials: O
authors.lastname: Ekwenna
authors.affiliation: Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.affiliation: Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL, 33136, USA. eperez3@med.miami.edu.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Health resources; Liver transplantation; Mortality; Outcome assessment; Pediatrics