LAUSR

Introduction/Hypothesis: No reliable method exists to evaluate how organ dysfunction (OD) following cardiopulmonary bypass in pediatric lung transplantation affects morbidity outcomes. Post lung transplantation, OD can reflect preoperative organ failure, intraoperative organ damage and post-operative complications. We evaluated the implementation of an OD scoring system; both the PEdiatric Logistic Organ Dysfunction (PELOD) and the pediatric Sequential Organ Failure Assessment (pSOFA) scores, to assess morbidity in pediatric lung transplant recipients (LTRs) following transplantation. Methods: Medical records of LTRs from January 2009 to March 2016 were reviewed. PELOD and pSOFA scores were calculated on post-transplant days 1, 2 and 3. Outcomes included intensive care unit (ICU) length of stay, number of days on artificial ventilation, vasoactive-inotropic score and worst primary graft dysfunction (PGD) score. Patients were divided into three groups based on their initial pSOFA score >=5 and subsequent trends either pSOFA >= 5 and uptrending or >=5 and downtrending. The same was applied towards the PELOD score: >=12, >= 12 and uptrending and >=12 and downtrending. Results: 98 patients, with a female predominance (54%) and a mean age of 12, were enrolled. Initial pSOFA >= 5 was associated with longer ventilator days (median 2 vs 1, p=0.003) and longer ICU hospitalization (median 8 vs 6 days, p=0.005). pSOFA >= 5 with uptrending score was also associated with longer ventilator days (median 4 vs 2, p=0.01) and longer ICU hospitalization (median 10 vs 5 days, p=0.02). Worst PGD score was associated with an initial pSOFA >= 5 (p=0.03). pSOFA <=5 and downtrending was not significantly associated with morbidity outcomes. The PELOD >= 12 and uptrending was not significant for any outcomes. Conclusions: There is no pediatric lung transplantation study evaluating post-operative severity of illness using a scoring system and its association with clinically significant outcomes. Higher pSOFA and uptrending pSOFA scores were associated with increased morbidity. pSOFA score can be a useful, objective tool for prompt recognition of critically ill pediatric patients after lung transplantation and can help predict morbidity as well as aid in the future standardization of therapeutic interventions.