Kristin Dolan, MD
Children's Mercy Hospital Kansas City
Houston, Texas
Disclosure information not submitted.
Moreshwar Desai, M.B;B.S.
Associate Professor of Pediatrics, Division of Pediatric Critical Care Medicine
Baylor College of Medicine/Texas Children's Hospital, United States
Disclosure information not submitted.
Poyyapakkam Srivaths, MD
Associate Professor
Baylor College of Medicine, Texas Children's Hospital, United States
Disclosure information not submitted.
Sanjiv Harpavat, MD, PhD
Assistant Professor of Pediatrics, Division of Gastroenterology and Nutrition
n/a, United States
Disclosure information not submitted.
John Goss, MD
Professor and Chief, Division of Abdominal Transplantation
Baylor College of Medicine/Texas Children's Hospital, United States
Disclosure information not submitted.
Trung Nguyen, MD
Associate Professor
Texas Childrens' Hospital/Baylor College of Medicine, Texas, United States
Disclosure information not submitted.
Ayse Akcan-Arikan, MD
Assoc Prof of Pediatrics, Medical Dir of Critical Care Nephrology
Baylor College of Medicine at Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Title: Functional Outcomes after Hybrid Extracorporeal Therapy in Pediatric Liver Failure
Introduction: Pediatric liver failure associated multiple organ dysfunction syndrome (MODS) can be bridged to liver transplantation or recovery via hybrid extracorporeal therapy (HET=combination of continuous renal replacement therapy, extracorporeal liver support, and plasmapheresis). We previously reported functional outcomes using Functional Status Score (FSS) amongst HET survivors at hospital discharge, where 40% were classified as good, 10% as mildly abnormal, and 50% were moderately abnormal. We aimed to evaluate morbidity beyond hospital discharge by determining functional outcomes of this HET cohort at 6,12, and 24 months following hospital discharge.
Methods: FSS was calculated at 6,12, and 24 months following hospital discharge and classified as good (FSS 6-7), mildly abnormal (8-9), moderately abnormal (10-15), severely abnormal (16-20), or very severely abnormal (21-30). If the FSS score increased more than or equal to 3 points, this was considered a new morbidity.
Results: Over 36 months, 20 patients, median age 8 years [IQR 1- 16] with liver failure who received HET had outpatient follow up at 6,12, and 24 months following discharge. FSS at discharge was 8 [IQR 6-10], at 6 months was 6 [6-8] and decreased to 6 [6-6] at 12 and 24 months (p=0.02 discharge vs 12 months, p< 0.01 discharge vs 24 months). When compared to discharge FSS, patient’s FSS was mostly unchanged (60%) or improved (30%) by 12 months. No patient had worsening FSS. At 24 months following discharge, 94% of the patients were unchanged or improved from their baseline. Only one patient had worsening FSS from baseline with a new morbidity of tracheostomy tube with ventilatory support.
Conclusions: HET survivors of pediatric liver failure have overall excellent functional outcomes at discharge with improvement in FSS at 12 and 24 months following discharge. Most patients returned to their baseline or even had improved FSS at 24 months following discharge.