998

Abstract

Introduction: Orthotopic liver transplantation (OLT) patients requiring renal replacement therapy (RRT) generally experience worse outcomes. The purpose of this study is to identify outcomes and survival predictors among pediatric OLT patients receiving perioperative RRT in the pediatric intensive care unit (PICU) and to identify predictors of successful RRT termination. Methods: An IRB-approved retrospective review of our hospital's pediatric patients (0-21 years of age) between January 1, 2000 and December 31, 2011 was conducted. Categorical associations with survival status were tested for statistical significance using Fisher's exact test. Continuous variables were compared between survival status using the Wilcoxon rank sum test or unpaired t-test as appropriate. A Kaplan-Meier curve was constructed to estimate survival rates over time. A mixed model was used to test for differences in urine output. A P-value <0.05 was considered statistically significant. Results: Seventeen patients received RRT within a perioperative OLT period (mean age, 9.23 years; range, 2 months-19 years). Mean BSA was 0.95 m2 (range, 0.14-1.95 m2). Survivors were older at the time of RRT (mean, 11.8 years v. 3 years, P=0.004) and had a higher BSA than non-survivors (mean, 1.18 years v. 0.40 years, P<0.01). Dialysis included intermittent and continuous modalities. Higher urine output during the last 24 hours of RRT was associated with successful RRT termination (mean, 1.36 mL/kg/h v. 0.47 mL/kg/h, P=0.002). Neither calculated glomerular filtration rate at PICU admission nor prior to starting RRT was associated with survival. Twelve patients (70%) survived to hospital discharge with one receiving a renal transplantation. One required dialysis after discharge. Survival from RRT initiation was 82% at 3 months, 76% at 6 months, 71% at one year and 65% at three years. Conclusions: Among pediatric OLT patients receiving perioperative RRT in the PICU, older age is associated with survival, and urine output during the last 24 hours of RRT predicts successful RRT termination. This study supports the use of RRT in pediatric perioperative OLT patients and may help guide patient selection and timing of RRT termination.