Most pediatric transplant centers are low volume, adult-focused, and in proximity to higher volume pediatric centers

Nichols, Tyler; Price, Matthew Brent; Villarreal, Joshua A.; Bakhtiyar, Syed Shahyan; Vierling, John M.; Cotton, Ronald T.; Galván, Nhu Thao Nguyen; O’Mahony, Christine A.; Goss, John A.; Rana, Abbas

doi:10.1016/j.jpedsurg.2019.10.019

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Specifically, low‐volume centers (≤3 per year) were associated with inferior graft outcomes, highlighting the complexity in treating the failing post‐Kasai BA population optimally. In our study ~28% of BA LT recipients were listed in low‐volume centres, similar to a recent study which showed around 30% of paediatric LTs to be listed in low volume centres 56 . The transplant community should thus make a concerted effort to study and disseminate best practices from medium or high volume cenres and consider regionalisation of this complex procedure in cases where expertise is not available.…”

Section: Discussionsupporting

confidence: 84%

“…20,[39][40][41][42] to a recent study which showed around 30% of paediatric LTs to be listed in low volume centres. 56 The transplant community should thus make a concerted effort to study and disseminate best practices from medium or high volume cenres and consider regionalisation of this complex procedure in cases where expertise is not available. Our study provides a blueprint for guiding transplant centre on volumes they should strive for which should hopefully help them boost their volume.…”

Section: Discussionmentioning

confidence: 99%

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Biliary atresia and liver transplantation in the United States: A contemporary analysis

Anouti,

Patel,

VanWagner

et al. 2023

Liver International

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BackgroundBiliary atresia (BA) remains the number one indication for paediatric liver transplantation (LT) worldwide but is an uncommon indication for older LT recipients. The impact of recent donor allocation changes, pervasive organ shortage and evolving LT practices on the BA LT population is unknown.MethodsWe identified patients who underwent LT between January 2010 and December 2021 using the UNOS database. We compared clinical outcomes between patients with BA and those with non‐BA cholestatic liver disease. Groups were stratified by age, <12 years (allocated via PELD system) and ≥12 years (allocated via MELD system). Waitlist outcomes were compared using competing‐risk regression analysis, graft survival rates were compared using Kaplan–Meier time‐to‐event analysis and Cox proportional hazards modelling provided adjusted estimates.ResultsThere were 2754 BA LT waitlist additions and 2206 BA LTs (1937 <12 years [younger], 269 ≥12 years [older]). There were no differences in waitlist mortality between BA and non‐BA cholestatic patients. Among BA LT recipients, there were 441 (20.0%) living‐donor liver transplantations (LDLT) and 611 (27.7%) split deceased‐donor LTs. Five‐year graft survival was significantly higher among BA versus non‐BA cholestatic patients in the older group (88.3% vs. 79.5%, p < .01) but not younger group (89.3% vs. 89.5%). Among BA LT recipients, improved graft outcomes were associated with LDLT (vs. split LT: HR: 2, 95% CI: 1.03–3.91) and higher transplant volume (volume >100 vs. <40 BA LTs: HR: 3.41, 95% CI: 1.87–6.2).ConclusionLiver transplant outcomes among BA patients are excellent, with LDLT and higher transplant centre volume associated with optimal graft outcomes.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Biliary atresia and liver transplantation in the United States: A contemporary analysis

Anouti,

Patel,

VanWagner

et al. 2023

Liver International

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“…Other studies have also demonstrated the importance of center volume on waiting lists and posttransplant outcomes in pediatric kidney and lung transplantation. [16][17][18] Our study similarly found that pediatric liver transplant center volume influences posttransplant graft survival. Specifically, we found that DDPLT center volume was associated with both recipient and graft survival.…”

Section: Discussionsupporting

confidence: 70%

Living Donor Liver Transplant Center Volume Influences Waiting List Survival Among Children Listed for Liver Transplantation

et al. 2022

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Background. Pediatric living donor liver transplantation (LDLT) remains infrequently performed in the United States and localized to a few centers. This study aimed to compare pediatric waiting list and posttransplant outcomes by LDLT center volume. Methods. The Scientific Registry of Transplant Recipients/Organ Procurement and Transplantation Network database was retrospectively reviewed for all pediatric (age <18 y) liver transplant candidates listed between January 1, 2009, and December 31, 2019. The average annual number of LDLT, deceased donor partial liver transplant (DDPLT), and overall (ie, LDLT + DDPLT + whole liver transplants) pediatric liver transplants performed by each transplant center during the study period was calculated. Results. Of 88 transplant centers, only 44 (50%) performed at least 1 pediatric LDLT during the study period. LDLT, DDPLT, and overall transplant center volume were all positively correlated. LDLT center volume was protective against waiting list dropout after adjusting for confounding variables (adjusted hazard ratio, 0.92; 95% confidence interval, 0.86-0.97; P = 0.004), whereas DDPLT and overall center volume were not (P > 0.05); however, DDPLT center volume was significantly protective against both recipient death and graft loss, whereas overall volume was only protective against graft loss and LDLT volume was not protective for either. Conclusions. High-volume pediatric LDLT center can improve waiting list survival, whereas DDPLT and overall volume are associated with posttransplant survival. Expertise in all types of pediatric liver transplant options is important to optimize outcomes.

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“…It appears that survival following transplantation in patients with PA seems to be improving with greater experience of the procedure. Indeed, the expertise and experience of the surgical team is an important prognostic factor for general paediatric liver transplantation [43][44][45][46].…”

Section: (15-5)mentioning

confidence: 99%

Post-transplantation Outcomes in Patients with PA or MMA: A Review of the Literature

2020

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Introduction: Liver transplantation is recognised as a treatment option for patients with propionic acidemia (PA) and those with methylmalonic acidemia (MMA) without renal impairment. In patients with MMA and moderate-to-severe renal impairment, combined liver-kidney transplantation is indicated. However, clinical experience of these transplantation options in patients with PA and MMA remains limited and fragmented. We undertook an overview of post-transplantation outcomes in patients with PA and MMA using the current available evidence. Methods: A literature search identified publications on the use of transplantation in patients with PA and MMA. Publications were considered if they presented adequate demographic and outcome data from patients with PA or risk of perioperative complications on an individual basis.

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Most pediatric transplant centers are low volume, adult-focused, and in proximity to higher volume pediatric centers

Cited by 6 publications

References 23 publications

Biliary atresia and liver transplantation in the United States: A contemporary analysis

Biliary atresia and liver transplantation in the United States: A contemporary analysis

Living Donor Liver Transplant Center Volume Influences Waiting List Survival Among Children Listed for Liver Transplantation

Post-transplantation Outcomes in Patients with PA or MMA: A Review of the Literature

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