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 23 May 2018

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News

Liver offers to pediatric candidates on the transplant wait list

October's issue of Gastroenterology examines deceased donor liver offer acceptance patterns and their contribution to pediatric wait-list mortality.

News image

Approximately 10% of children on the liver transplant wait-list in the United States die every year.

Dr Evelyn Hsu and colleagues examined deceased donor liver offer acceptance patterns and their contribution to pediatric wait-list mortality.

The research team performed a retrospective cohort study of children on the US liver transplant wait-list from 2007 through 2014 using national transplant registry databases.

The researchers determined the frequency, patterns of acceptance, and donor and recipient characteristics associated with deceased donor liver organ offers for children who died or were delisted compared with those who underwent transplantation.

55% received an offer of 1 or more liver that was subsequently transplanted into another pediatric recipient
Gastroenterology

Children who died or were delisted were classified by the number of donor liver offers, limiting analyses to offers of livers that were ultimately transplanted into pediatric recipients. The primary outcome was death or delisting on the wait-list.

Among 3852 pediatric liver transplant candidates, children who died or were delisted received a median 1 pediatric liver offer, and waited a median 33 days before removal from the wait-list.

The team found that of 11,328 donor livers offered to children, 12% were transplanted into children.

The researchers noted that 47% were immediately accepted, and 53% were initially refused and eventually accepted for another child.

Of 27,831 adults, the research team showed that 6% received livers from donors younger than 18 years, most were allocated locally or regionally.

Of children who died or were delisted, 55% received an offer of 1 or more liver that was subsequently transplanted into another pediatric recipient, and 45% died or were delisted with no offers.

Dr Hsu's team concludes, "Among pediatric liver transplant candidates in the US, children who died or were delisted received a median 1 pediatric liver offer and waited a median of 33 days."

"Of livers transplanted into children, 47% were immediately accepted and 53% were initially refused and eventually accepted for another child."

"Of children who died or were delisted, 55% received an offer of 1 or more liver that was subsequently transplanted into another pediatric recipient, and 45% died or were delisted with no offers."

"Pediatric prioritization in the allocation and development of improved risk stratification systems is required to reduce wait-list mortality among children."

Gastroenterol 2017: 153(4): 988–995
05 October 2017

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