(1709) Sedation Practices and Outcomes in Pediatric Liver Transplant Patients Utilizing Linked Databases

Introduction: Roughly 2/3 of patients remain intubated and mechanically ventilated following liver transplantation, requiring analgesia and sedation medications. Many of these medications are hepatically metabolized, which may be altered after liver transplantation. Risks of these medications include hypotension, which may impact new graft perfusion and subsequently, graft function. Recent literature has described sedation ordering practices in this population; however, little is known regarding receipt of sedative medications and patient and transplant outcomes.

Methods: This retrospective cohort study described the association between sedation practices and patient and transplant-related outcomes in pediatric liver transplant recipients between October 1, 2015 and December 31, 2022. The Pediatric Health Information System (PHIS) database, an administrative database from the Children’s Hospital Association, and the Scientific Registry of Transplant Recipients (SRTR) database, the national transplant database, were merged utilizing indirect identifiers. Our primary outcome was hospital length of stay. Secondary outcomes included ICU length of stay, mechanical ventilation days, and in-hospital mortality as well as transplant-related outcomes. To determine other risk factors associated with prolonged length of stay, a multivariable logistic regression was performed.

Results: A total of 2044 patients met inclusion criteria and were successfully merged across SRTR and PHIS. The median age was 2 years (IQR 0-9) and 1021 (50%) were male. The most common principal diagnosis was biliary atresia (345, 16.9%). Most (1232, 60%) received a whole-liver transplant. The most common analgesia and sedation combination was dexmedetomidine, opioid, and benzodiazepine (966, 47.3%). Compared to other sedation combinations, this group had the longest length of stay (29 days, [IQR 18-56], p< 0.0001). Sedation group was a significant predictor of length of stay, even after controlling for relevant covariates. Associations between sedation group and surgical outcomes pending.

Conclusions: In a pediatric liver transplantation population, the type of sedation patients received post-operatively was associated with differences in length of stay after adjusting for patient- and transplant-related risk factors.