Impact of pretransplant growth retardation in pediatric liver transplantation

J Pediatr Gastroenterol Nutr. 2006 Jul;43(1):89-94. doi: 10.1097/01.mpg.0000226378.03247.1f.

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.

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Anthropometry
  • Biliary Atresia / economics
  • Biliary Atresia / surgery
  • Body Height
  • Body Weight
  • Child
  • Child, Preschool
  • Female
  • Graft Survival
  • Growth Disorders* / economics
  • Hospital Costs
  • Humans
  • Infant
  • Length of Stay / economics
  • Liver Failure, Acute / economics
  • Liver Failure, Acute / surgery
  • Liver Transplantation* / economics
  • Male
  • Malnutrition / economics
  • Nutritional Status
  • Survival Analysis
  • Texas / epidemiology
  • Treatment Outcome