*Purpose: PELD scores are used to reduce waitlist mortality, but they do not accurately predict likelihood of prolonged length of stay or higher costs associated with it. This study aims to create a pediatric length of stay (LOS) index to predict increased risk of prolonged stay following liver transplantation.

*Methods: The scoring system generated predicts length of stay following pediatric liver transplantation. With univariate and multivariate analyses on data from 7513 pediatric liver transplant recipients, independent recipient/donor risk factors for prolonged stay (>30 days) were identified. Multiple imputations accounted for missing variables.

*Results: The most significant factors were hemodialysis 1 week before transplantation (OR 2.17, CI 1.63- 2.89), ICU admission (OR 2.12, CI 1.75-2.56) and recipient weight <5 kg (OR 2.11, CI 1.64-2.70). The LOS index assigns weighted scoring points to factors to predict prolonged stay (C-statistic of 0.73). The index demonstrated discrimination across the population, dividing it into quartiles, (OR 2.24 (CI 2.13-2.35), 2.45 (CI 2.33-2.57), and 4.73 (CI 4.69-4.77), for prolonged stay.

*Conclusions: The pediatric LOS index, utilizing 17 donor/recipient factors, can assess the risk for pediatric liver transplantation prolonged stay. Important predictive factors are hemodialysis, ICU admission, recipient weight and bilirubin, previous transplantation, and recipient life support status.

Figure 1. Kaplan-Meier curve of hospital length of stay by the LOS index. Abscissa-Percentage of recipients. Ordinate-Hospital days until discharge following liver transplantation. P value < .001 for each group by log-rank test with reference to the short-stay group.

Figure 2. Area Under the Receiver Operating Curve (C-Statistic) for Pediatric LOS Index.

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