Predicting chance of liver transplantation for pediatric wait‐list candidates

Abstract

Information about wait‐list time has been reported as one of the single most frequently asked questions by individuals awaiting a transplant but data regarding wait‐list time have not been processed in a useful way for pediatric candidates. To predict chance of receiving a DDLT, we identified 6471 pediatric (<18 years), non status‐1A, liver‐only transplant candidates between 2006 and 2017 from the SRTR. Cox regression with shared frailty for DSA level effect was used to model the association of blood type, weight, allocation PELD and MELD, and DSA with chance of DDLT. Jackknife technique was used for validation. Median (interquartile range) wait‐list time was 100 (34‐309) days. Non‐O Blood type, higher PELD/MELD score at listing, and DSA were associated with increased chance of DDLT, while age 1‐5 years and 10‐18 years was associated with lower chance of DDLT (P < 0.001 for all variables). Our model accurately predicted chance of transplant (C‐statistic = 0.68) and was able to predict DDLT at specific follow‐up times (eg, 3 months). This model can serve as the basis for an online tool that would provide useful information for pediatric wait‐list candidates.

Increased use of split liver grafts in adult recipients following implementation of a pediatric liver transplant program

“…In our cohort, the median waitlist time for the pediatric recipients was 89 (64-114) days, shorter than previously reported national waitlist times (100 [34-309] days). 23 The same trend was seen for adult recipients as well, with reduced waitlist times than previous reports. 24 However, despite these known benefits, SLT underutilization resides in big part on the high demanding logistics.…”

“…The positive effect on reduction of waitlist time and increase in organ pool by using split livers is evident. In our cohort, the median waitlist time for the pediatric recipients was 89 (64–114) days, shorter than previously reported national waitlist times (100 [34–309] days) 23 . The same trend was seen for adult recipients as well, with reduced waitlist times than previous reports 24 .…”

“…Median follow-up for the entire cohort was 721 (247-1293.5) days, 736 days among adult recipients and 629 (306-1095) days among pediatric recipients. Median length of stay was 7 (5.5-10) days in adult recipients, and 24(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) days in pediatric recipients. After surgery, the parameters of liver function improved in all patients as expected.…”

Living Donor Versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-analysis

“…49 In the United States, pediatric waitlist mortality is reported to be around 8%-12% per year with a median waiting time of 100 d, with patients <1 y of age experiencing a disproportionately high rate of morbidity and mortality. [49][50][51] Although splitting a deceased donor liver can improve access to size-matched allografts for pediatric candidates, 2 recent analyses of US data illustrated that only a small percentage ranging from 3.4% to 3.8% of "splittable" deceased donor grafts were actually split. 3,52 Even with new allocation policies, the logistics of having a procurement surgeon with appropriate technical expertise, performing technically demanding surgery at offsite facilities, and appropriately allocating the remaining right trisegment graft are all major barriers in practice.…”