Introduction:

Incidence and risk factors for early hospital readmission are poorly defined in pediatric liver transplant recipients, despite the importance of this outcome. We evaluated risk factors for hospital readmission for pediatric liver transplant recipients in a nationally representative sample.

Methods:

We retrospectively analyzed data on 1,457 pediatric liver-only recipients transplanted 2011-2022 from the Society of Pediatric Liver Transplantation database. Recipient, donor, and hospitalization characteristics were evaluated as possible risk factors for readmission within 30 days of hospital discharge using multivariable modified Poisson regression.

Results:

Overall, 23% (N=330) of pediatric liver transplant recipients were readmitted within 30 days of discharge. Independent risk factors include diabetes (aIRR 2.85, 95% CI 1.66-4.92, p<0.001) and prior history of malignancy (aIRR 1.74, 95% CI 1.22-2.48, p=0.002). There was a significantly lower risk of readmission for hospital lengths of stay greater than the 75th percentile (>24 days) (aIRR 0.11, 95% CI 0.05-0.25, p <0.001), ages 11-17 compared to less than 1 (aIRR 0.52, 95% CI 0.30-0.91, p=0.021) and those with primary diagnosis of biliary atresia (aIRR 0.68, 95% CI 0.4-0.95, p=0.024). There was no associated difference in risk for race, gender, donor type (DCD, DBD, Living), procedure type (whole or split liver), cold and warm ischemic time, or insurance status.

Conclusion:

We found that 23% of pediatric liver transplant recipients were readmitted within 30 days. This readmission rate is lower than what has been reported for adult liver transplant recipients (33-55%), possibly due to longer lengths of stay for pediatric recipients for pre-discharge optimization.