Objectives: 

Neurologic complications occur in up to 40% of adult abdominal solid organ transplant recipients and are associated with increased mortality. Comparable pediatric data are sparse. This study describes the occurrence of neurologic and behavioral complications (neurobehavioral complications) in pediatric abdominal solid organ transplant recipients. We examine the association of these complications with length of stay, mortality, and tacrolimus levels.

Design: 

The electronic health record was interrogated for inpatient readmissions of pediatric abdominal solid organ transplant recipients from 2009 to 2017. A computable composite definition of neurobehavioral complication, defined using structured electronic data for neurologic and/or behavioral phenotypes, was created.

Setting: 

Quaternary children’s hospital with an active transplant program.

Patients: 

Pediatric abdominal solid organ transplant recipients.

Interventions: 

None.

Measurements and Main Results: 

Computable phenotypes demonstrated a specificity 98.7% and sensitivity of 63.0% for identifying neurobehavioral complications. There were 1,542 readmissions among 318 patients, with 65 (20.4%) having at least one admission with a neurobehavioral complication (total 109 admissions). Median time from transplant to admission with neurobehavioral complication was 1.2 years (interquartile range, 0.52–2.28 yr). Compared to encounters without an identified neurobehavioral complication, encounters with a neurobehavioral complication were more likely to experience ICU admission (odds ratio, 3.9; 2.41–6.64; p < 0.001), have longer ICU length of stay (median 10.3 vs 2.2 d; p < 0.001) and hospital length of stay (8.9 vs 4.3 d; p < 0.001), and demonstrate higher maximum tacrolimus level (12.3 vs 9.8 ng/mL; p = 0.001). Patients with a neurobehavioral complication admission were more likely to die (odds ratio, 5.04; 1.49–17.09; p = 0.009). In a multivariable analysis, type of transplant, ICU admission, and tacrolimus levels were independently associated with the presence of a neurobehavioral complication.

Conclusions: 

Common electronic health record variables can be used to accurately identify neurobehavioral complications in the pediatric abdominal solid organ transplant population. Late neurobehavioral complications are associated with increased hospital resource utilization, mortality, and tacrolimus exposure. Additional studies are required to delineate the relationship between maximum tacrolimus level and neurobehavioral complications to guide therapeutic drug monitoring and dosing.

中文翻译：

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使用可计算复合定义确定的儿科腹部器官移植受者中与神经行为并发症相关的因素。

目标： 

高达 40% 的成人腹部实体器官移植受者出现神经系统并发症，并与死亡率增加有关。可比较的儿科数据很少。本研究描述了儿科腹部实体器官移植受者发生的神经和行为并发症（神经行为并发症） 。我们研究了这些并发症与住院时间、死亡率和他克莫司水平的关系。

设计： 

2009 年至 2017 年儿童腹部实体器官移植接受者住院再入院的电子健康记录被审问。创建了神经行为并发症的可计算复合定义，使用神经和/或行为表型的结构化电子数据定义。

环境： 

具有积极移植计划的第四纪儿童医院。

患者： 

小儿腹部实体器官移植受者。

干预： 

没有任何。

测量和主要结果： 

可计算表型在识别神经行为并发症方面表现出 98.7% 的特异性和 63.0% 的敏感性。318 名患者中有 1,542 人再次入院，其中 65 人（20.4%）至少有 1次因神经行为并发症入院（总共 109 人入院）。从移植到因神经行为并发症入院的中位时间为 1.2 年（四分位距，0.52-2.28 年）。与未发现神经行为并发症的患者相比，患有神经行为并发症的患者更有可能进入 ICU（优势比，3.9；2.41-6.64；p < 0.001），入住 ICU 时间更长（中位数 10.3 对 2.2 天；p< 0.001）和住院时间（8.9 vs 4.3 d；p < 0.001），并表现出更高的最大他克莫司水平（12.3 vs 9.8 ng/mL；p = 0.001）。有神经行为并发症入院的患者更有可能死亡（优势比，5.04；1.49-17.09；p = 0.009）。在一项多变量分析中，移植类型、入住 ICU 和他克莫司水平与神经行为并发症的存在独立相关。

结论： 

常见的电子健康记录变量可用于准确识别儿科腹部实体器官移植人群的神经行为并发症。晚期神经行为并发症与医院资源利用率、死亡率和他克莫司暴露增加有关。需要更多的研究来描述最大他克莫司水平与神经行为并发症之间的关系，以指导治疗药物的监测和给药。