{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:19:42Z","timestamp":1791893982695,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Children at high risk for prolonged mechanical ventilation (PMV) after liver transplantation (LT) need to be identified early to optimize pulmonary support, allocate resources, and improve surgical outcomes. We aimed to develop and validate a metric that can estimate risk for Prolonged Ventilation After LT (PROVE\u2010ALT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified preoperative risk factors for PMV by univariable analysis in a retrospective cohort of pediatric LT recipients between 2011 and 2017 (<jats:italic>n<\/jats:italic>\u2009=\u2009205; derivation cohort). We created the PROVE\u2010ALT score by mapping multivariable logistic regression coefficients as integers, with cutoff values using the Youden Index. We validated the score by C\u2010statistic in a retrospectively collected separate cohort of pediatric LT recipients between 2018 and 2021 (<jats:italic>n<\/jats:italic>\u2009=\u2009133, validation cohort).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among total 338 patients, 21% (<jats:italic>n<\/jats:italic>\u2009=\u200972) were infants; 49% (<jats:italic>n<\/jats:italic>\u2009=\u2009167) had cirrhosis; 8% (<jats:italic>n<\/jats:italic>\u2009=\u200927) required continuous renal replacement therapy (CRRT); and 32% (<jats:italic>n<\/jats:italic>\u2009=\u2009111) required management in hospital (MIH) before LT. Incidence of PMV post\u2010LT was 20% (<jats:italic>n<\/jats:italic>\u2009=\u200969) and 3% (<jats:italic>n<\/jats:italic>\u2009=\u200912) required tracheostomy. Independent risk factors (OR [95% CI]) for PMV were cirrhosis (3.8 [1\u201314], <jats:italic>p<\/jats:italic>\u2009=\u2009.04); age &lt;1\u2010year (8.2 [2\u201330], <jats:italic>p<\/jats:italic>\u2009=\u2009.001); need for preoperative CRRT (6.3 [1.2\u201332], <jats:italic>p<\/jats:italic>\u2009=\u2009.02); and MIH before LT (12.4 [2.1\u201371], <jats:italic>p<\/jats:italic>\u2009=\u2009.004). PROVE\u2010ALT score \u22658 [Range\u2009=\u20090\u201321] accurately predicted PMV in the validation cohort with 73% sensitivity and 80% specificity (AUC: 0.81; 95% CI: 0.71\u20130.91).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PROVE\u2010ALT can predict PMV after pediatric LT with a high degree of sensitivity and specificity. Once externally validated in other centers, PROVE\u2010ALT will empower clinicians to plan patient\u2010specific ventilation strategies, provide parental anticipatory guidance, and optimize hospital resources.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14623","type":"journal-article","created":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T06:14:41Z","timestamp":1697264081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Estimating risk of prolonged mechanical ventilation after liver transplantation in children: <scp>PROVE\u2010ALT<\/scp> score"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9144-3007","authenticated-orcid":false,"given":"Muhammad Umair M.","family":"Mian","sequence":"first","affiliation":[{"name":"Division of Child Health University of Missouri School of Medicine, Springfield Clinical Campus  Columbia Missouri 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