Abstract
Pediatric lung transplantations (LTx) consists of a relatively small but significant population. Without pooling of multi-institutional data, setting expectations for length of stay (LOS) is difficult. This study aims to investigate the LOS in LTx over the last 20 years to help benchmarking and quality improvement work. The United Network for Organ Sharing (UNOS) database was used to identify patients ages 0-18 at time of listing for LTx between 2000 and 2019. This timeframe was divided into two eras: first (2000-2009) and second (2010-2019) eras. LOS was defined as number of days from LTx to discharge. 905 LTx were identified. 471 transplantations occurred in the first era and 434 in the second. Overall length of stay [median days (IQR)] was 19 (13-31) and comparable between the eras [18 (13-29) vs 20 (14-35), p=0.082]. Specifically by age, LOS for infants was 44 (29-80), for ages 2-11 was 21 (13-37), and for ages 12-18 was 17 (12-26). Compared to patients who did not have each of the following, LOS was increased in patients on ECMO (p<0.001), with ventilator-dependence (p<0.001), with renal dysfunction (eGFR<60 mL/min/1.73m2, p=0.006), or with hepatic dysfunction (total bilirubin≥1mg/dl, p=0.012) at the time of transplantation; and in patients re-intubated post-transplantation (p<0.001). However, these patient groups had no change in LOS when comparing eras. On KM analysis, post-transplantation survival in the second era (one-year survival 85%) was not significantly different compared to the first era (one-year survival 84%, p=0.464). Over the past two decades, lung transplantation patients who are younger or who have pre- or post-transplantation end-organ dysfunction consistently have longer LOS. With these stable patterns, healthcare moving towards a bundled-care system, and an increase in UNOS required & institutional Quality Improvement projects, establishing benchmarks and expectations in pediatric post-lung transplant LOS is important.
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