Abstract
Background
Kidney transplants (KT) are accepted as the kidney replacement therapy of choice for children with kidney failure. The surgery itself may be more difficult especially in small children, and often leads to significant hospital stays. There is little research on predicting prolonged length of stay (LOS) in children. We aim to examine the factors associated with prolonged LOS following pediatric KT to help clinicians make informed decisions, better counsel families, and potentially reduce preventable causes of prolonged stay.
Methods
We retrospectively analyzed the United Network for Organ Sharing database for all KT recipients less than 18 years old between January 2014 and July 2022 (n = 3693). Donor and recipient factors were tested in univariate and multivariate logistic analysis using stepwise elimination of non-significant factors to create a final regression model predicting LOS longer than 14 days. Values were assigned to significant factors to create risk scores for each individual patient.
Results
In the final model, only primary diagnosis of focal segmental glomerulosclerosis, dialysis prior to KT, geographic region, and recipient weight prior to KT were significant predictors of LOS longer than 14 days. The C-statistic of the model is 0.7308. The C-statistic of the risk score is 0.7221.
Conclusions
Knowledge of the risk factors affecting prolonged LOS following pediatric KT can help identify patients at risk of increased resource use and potential hospital-acquired complications. Using our index, we identified some of these specific risk factors and created a risk score that can stratify pediatric recipients into low, medium, or high risk groups.
Graphical Abstract
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Data availability
The data that support the findings of this study are openly available in the OPTN STAR File Directory at https://optn.transplant.hrsa.gov/data/view-data-reports/request-data/.
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DiLeo, M.J., Miggins, J.J., Brewer, E.D. et al. A novel risk score for predicting prolonged length of stay following pediatric kidney transplant. Pediatr Nephrol 38, 4187–4196 (2023). https://doi.org/10.1007/s00467-023-06066-x
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DOI: https://doi.org/10.1007/s00467-023-06066-x