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Impact of Pretransplant Growth Retardation in Pediatric Liver Transplantation

2006; Lippincott Williams & Wilkins; Volume: 43; Issue: 1 Linguagem: Inglês

10.1097/01.mpg.0000226378.03247.1f

1536-4801

Neal R. Barshes, I‐Fen Chang, Saul J. Karpen, Beth A. Carter, John A. Goss,

Nutrition and Health in Aging

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. Abbreviations: OLT, orthotopic liver transplantation‐PELD, Pediatric End‐Stage Liver Disease Model.