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. 2018 Nov 1;172(11):1070-1077.
doi: 10.1001/jamapediatrics.2018.2541.

Accuracy of the Pediatric End-stage Liver Disease Score in Estimating Pretransplant Mortality Among Pediatric Liver Transplant Candidates

Chung-Chou H Chang  1   2   3 , Cindy L Bryce  1   3   4 , Benjamin L Shneider  5 , Jonathan G Yabes  1   2   3 , Yi Ren  2 , Gabriel L Zenarosa  6 , Heather Tomko  4 , Drew M Donnell  2   4 , Robert H Squires  7 , Mark S Roberts  1   3   4   6
Affiliations

Accuracy of the Pediatric End-stage Liver Disease Score in Estimating Pretransplant Mortality Among Pediatric Liver Transplant Candidates

Chung-Chou H Chang et al. JAMA Pediatr. .

Abstract

Importance: Fair allocation of livers between pediatric and adult recipients is critically dependent on the accuracy of mortality estimates afforded by the Pediatric End-stage Liver Disease (PELD) and Model for End-stage Liver Disease, respectively. Widespread reliance on exceptions for pediatric recipients suggests that the 2 systems may not be comparable.

Objective: To evaluate the accuracy of the PELD score in estimating 90-day pretransplant mortality among pediatric patients on the United Network for Organ Sharing (UNOS) waiting list.

Design, setting, and participants: Patients who were listed from February 27, 2002, to March 31, 2014, for primary liver transplant were included in this retrospective analysis and were followed up for at least 2 years through June 17, 2016. The study analyzed 2 cohorts using the UNOS Standard Transplant Analysis and Research data files. The full cohort comprised 4298 patients (<18 years of age) who had chronic liver disease (excluding cancer). The reduced cohort (n = 2421) excluded patients receiving living donor transplantation or PELD exception points.

Main outcomes and measures: Observed and expected 90-day pretransplant mortality rates evaluated at 10-point interval PELD levels.

Results: Among the 4298 patients in the full cohort (mean [SD] age, 2.5 [4.2] years; 2251 [52.4%] female; 2201 [51.2%] white), PELD scores and mortality were concordant (C statistic, 0.8387 [95% CI, 0.8191-0.8584] for the full cohort and 0.8123 [95% CI, 0.7919-0.8327] for the reduced cohort). However, the estimated 90-day mortality using the PELD score underestimated the actual probability of death by as much as 17%.

Conclusions and relevance: With use of the PELD score, the ranking of risk among children was preserved, but direct comparisons between adult and pediatric candidates were not accurate. Children with chronic liver disease who are in need of transplant may be at a disadvantage compared with adults in a similar situation.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Assembly of Analysis Cohorts
PELD indicates Pediatric End-stage Liver Disease.
Figure 2.
Figure 2.. Actual and Estimated 90-Day Pretransplant Mortality by Pediatric End-stage Liver Disease (PELD) Score
Orange shading indicates the 95% CI for the reduced cohort; gray shading, 95% CI for the full cohort.
Figure 3.
Figure 3.. Actual and Estimated 90-Day Pretransplant Mortality by Pediatric End-stage Liver Disease (PELD) Score in Each Disease Diagnosis Category at Listing
Orange shading indicates the 95% CI for the reduced cohort; gray shading, 95% CI for the full cohort.
See this image and copyright information in PMC

Comment in

References

    1. Neto JS, Carone E, Pugliese RP, et al. Modified pediatric end-stage liver disease scoring system and pediatric liver transplantation in Brazil. Liver Transpl. 2010;16(4):426-430. - PubMed
    1. Rhee C, Narsinh K, Venick RS, et al. Predictors of clinical outcome in children undergoing orthotopic liver transplantation for acute and chronic liver disease. Liver Transpl. 2006;12(9):1347-1356. doi: 10.1002/lt.20806 - DOI - PubMed
    1. Shneider BL, Neimark E, Frankenberg T, Arnott L, Suchy FJ, Emre S. Critical analysis of the pediatric end-stage liver disease scoring system: a single center experience. Liver Transpl. 2005;11(7):788-795. doi: 10.1002/lt.20401 - DOI - PubMed
    1. Shneider BL, Suchy FJ, Emre S. National and regional analysis of exceptions to the Pediatric End-Stage Liver Disease scoring system (2003-2004). Liver Transpl. 2006;12(1):40-45. doi: 10.1002/lt.20662 - DOI - PubMed
    1. Sindhi R, Soltys K, Bond G, Marcos A, Mazariegos G. PELD allocation and acute liver/graft failure. Liver Transpl. 2007;13(5):776-777. doi: 10.1002/lt.21102 - DOI - PubMed

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