Abstract：
BACKGROUND: Pediatric liver transplantation is a very resource-intensive therapy. This study aimed to identify the changes made between two epochs of management and analyze their influence on length of stay (LOS).
METHODS: Data from a single center were obtained from the liver transplant and Pediatric Intensive Care Unit (PICU) databases for 336 transplants (282 children) performed between 2000 and 2021. Transplants were analyzed in two epochs, before and after July 2012, representing a change in postoperative anticoagulation management. Differences in graft recipient demographics and perioperative management factors were compared between epochs. Multivariate regression was performed to identify the complications that correlated most strongly with hospital LOS.
RESULTS: There was a difference in hospital LOS between Epoch 1 (Median = 31.7 days) and Epoch 2 (Median = 26.3 days) (p < 0.001), but not in PICU LOS (E1 Median = 7.3 days, E2 Median = 7.4 days; p = 0.792). Epoch 2 saw increased use of split grafts (60.6% of total), decreased pediatric end-stage liver disease (PELD) score at transplant (Average = 16.7; p < 0.001), decreased invasive ventilation time (Average = 4.48 days; p < 0.001), and decreased hepatic artery thrombosis (HAT) rates (E1 = 14.4%, E2 = 4.3%; p < 0.001) without an associated increase in bleeding rates.
CONCLUSIONS: Hospital LOS has reduced in Epoch 2 due to refinements in intraoperative and postoperative management. There is increased emphasis on early extubation and increased use of noninvasive ventilatory techniques in Epoch 2. Split grafts have effectively expanded our graft donor pool and reduced transplant waitlist times.
METHODS: Data from a single center were obtained from the liver transplant and Pediatric Intensive Care Unit (PICU) databases for 336 transplants (282 children) performed between 2000 and 2021. Transplants were analyzed in two epochs, before and after July 2012, representing a change in postoperative anticoagulation management. Differences in graft recipient demographics and perioperative management factors were compared between epochs. Multivariate regression was performed to identify the complications that correlated most strongly with hospital LOS.
RESULTS: There was a difference in hospital LOS between Epoch 1 (Median = 31.7 days) and Epoch 2 (Median = 26.3 days) (p < 0.001), but not in PICU LOS (E1 Median = 7.3 days, E2 Median = 7.4 days; p = 0.792). Epoch 2 saw increased use of split grafts (60.6% of total), decreased pediatric end-stage liver disease (PELD) score at transplant (Average = 16.7; p < 0.001), decreased invasive ventilation time (Average = 4.48 days; p < 0.001), and decreased hepatic artery thrombosis (HAT) rates (E1 = 14.4%, E2 = 4.3%; p < 0.001) without an associated increase in bleeding rates.
CONCLUSIONS: Hospital LOS has reduced in Epoch 2 due to refinements in intraoperative and postoperative management. There is increased emphasis on early extubation and increased use of noninvasive ventilatory techniques in Epoch 2. Split grafts have effectively expanded our graft donor pool and reduced transplant waitlist times.
摘要：
背景：小儿肝移植是一种资源非常密集的治疗方法。这项研究旨在确定两个管理时期之间的变化，并分析其对住院时间（LOS）的影响。
方法：来自单个中心的数据来自2000年至2021年间进行的336例移植（282名儿童）的肝移植和儿科重症监护病房（PICU）数据库。移植在两个时期进行了分析，2012年7月前后,表明术后抗凝管理发生了变化.比较了不同时期移植受体人口统计学和围手术期管理因素的差异。进行多因素回归以确定与医院LOS相关性最强的并发症。
结果：在第1时期（中位数=31.7天）和第2时期（中位数=26.3天）之间的医院LOS存在差异（p<0.001），但不在PICULOS中（E1中位数=7.3天，E2中位数=7.4天；p=0.792）。时代2看到分裂移植物的使用增加（占总数的60.6%），移植时儿科终末期肝病（PELD）评分降低（平均=16.7；p<0.001），有创通气时间缩短（平均=4.48天；p<0.001），和降低肝动脉血栓形成（HAT）率（E1=14.4％，E2=4.3％；p<0.001）没有相关的出血率增加。
结论：由于术中和术后管理的改进，在第2时代，医院LOS降低了。在时代2中，人们越来越重视早期拔管和越来越多地使用无创通气技术。分裂移植物有效地扩大了我们的移植物供体库，并减少了移植等待名单的时间。
方法：来自单个中心的数据来自2000年至2021年间进行的336例移植（282名儿童）的肝移植和儿科重症监护病房（PICU）数据库。移植在两个时期进行了分析，2012年7月前后,表明术后抗凝管理发生了变化.比较了不同时期移植受体人口统计学和围手术期管理因素的差异。进行多因素回归以确定与医院LOS相关性最强的并发症。
结果：在第1时期（中位数=31.7天）和第2时期（中位数=26.3天）之间的医院LOS存在差异（p<0.001），但不在PICULOS中（E1中位数=7.3天，E2中位数=7.4天；p=0.792）。时代2看到分裂移植物的使用增加（占总数的60.6%），移植时儿科终末期肝病（PELD）评分降低（平均=16.7；p<0.001），有创通气时间缩短（平均=4.48天；p<0.001），和降低肝动脉血栓形成（HAT）率（E1=14.4％，E2=4.3％；p<0.001）没有相关的出血率增加。
结论：由于术中和术后管理的改进，在第2时代，医院LOS降低了。在时代2中，人们越来越重视早期拔管和越来越多地使用无创通气技术。分裂移植物有效地扩大了我们的移植物供体库，并减少了移植等待名单的时间。
