Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;21(1):222-228.
doi: 10.1111/ajt.15925. Epub 2020 May 29.

Improving the predictive ability of the pediatric end-stage liver disease score for young children awaiting liver transplant

Evelyn Hsu  1 , David P Schladt  2 , Andrew Wey  2 , Emily R Perito  3 , Ajay K Israni  2   4   5
Affiliations
Free article

Improving the predictive ability of the pediatric end-stage liver disease score for young children awaiting liver transplant

Evelyn Hsu et al. Am J Transplant. 2021 Jan.
Free article

Abstract

The current pediatric end-stage liver disease (PELD) score underestimates pediatric waitlist mortality. Children frequently require PELD exception points to achieve appropriate priority ranking. We developed a new PELD score using serum sodium, creatinine, and updated original PELD components to more accurately rank children and equalize children's mortality risk with the age-standardized mortality rate of adults. We included children aged younger than 12 years with chronic liver disease, listed for deceased donor livers January 1, 2005-December 31, 2017. Pediatric candidates (n = 5111) were followed from listing to the earliest of waitlist mortality (death or removal from the list due to being too sick to undergo transplant, n = 339) or 180 days. We incorporated linear splines for the current components of PELD and added sodium and creatinine to the equation. The updated PELD-Na-Cr had a cross-validated AUC ROC of 0.854, vs 0.799 for the original PELD. PELD-Na-Cr required 9.44 additional points to equalize children's mortality risk with the age-standardized mortality rate of adults. PELD-Na-Cr better ordered the sickest children and should better prioritize children relative to adults. As a result, PELD-Na-Cr could increase pediatric transplant rates and reduce pediatric liver transplant waitlist mortality.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
    1. Elwir S, Lake J. Current status of liver allocation in the United States. Gastroenterol Hepatol (NY). 2016;12(3):166-170.
    1. McDiarmid SV, Anand R, Lindblad AS. Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group. Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation. 2002;74(2):173-181.
    1. Mazariegos G, Anand R, Mcdiarmid S, et al. Validation of PELD severity score in a pediatric transplant candidate database. Am J Transplant. 2002;2(S3):249-276 [abstract 451].
    1. Chang C-C, Bryce CL, Shneider BL, et al. Accuracy of the pediatric end-stage liver disease score in estimating pretransplant mortality among pediatric liver transplant candidates. JAMA Pediatr. 2018;172(11):1070-1077.

Publication types