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J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):472-479. doi: 10.1097/MPG.0000000000002287.

The Impact of Increased Allocation Priority for Children Awaiting Liver Transplant: A Liver Simulated Allocation Model (LSAM) Analysis.

Author information

1
Department of Pediatrics, University of California San Francisco, San Francisco, CA.
2
Department of Pediatrics, Johns Hopkins University, Baltimore.
3
Department of Mathematics, United States Naval Academy, Annapolis, MD.
4
Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
5
Department of Pediatrics, Recanati Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY.
6
Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT.
7
Department of Pediatrics, University of Washington, Seattle, WA.
8
Department of Surgery, Harvard Medical School, Boston, MA.
9
Department of Pediatrics, Baylor College of Medicine, Houston, TX.
10
Department of Pediatrics, University of Toronto, Toronto, Canada.
11
Department of Surgery, University of Washington, Seattle, WA.
12
Department of Surgery, Primary Children's Hospital, Salt Lake City, UT.
13
Department of Pediatrics, Yale University School of Medicine, New Haven, CT.

Abstract

OBJECTIVE:

The aim of the study was to investigate the impact of prioritizing infants, children, adolescents, and the sickest adults (Status 1) for deceased donor livers. We compared outcomes under two "SharePeds" allocation schema, which prioritize children and Status 1 adults for national sharing and enhanced access to pediatric donors or all donors younger than 35 years, to outcomes under the allocation plan approved by the Organ Procurement and Transplant Network in December 2017 (Organ Procurement and Transplantation Network [OPTN] 12-2017).

METHODS:

The 2017 Liver Simulated Allocation Model and Scientific Registry of Transplant Recipients data on all US liver transplant candidates and liver offers 7/2013 to 6/2016 were used to predict waitlist deaths, transplants, and post-transplant deaths under the OPTN 12-2017 and SharePeds schema.

RESULTS:

Prioritizing national sharing of pediatric donor livers with children (SharePeds 1) would decrease waitlist deaths for infants (<2 years, P = 0.0003) and children (2-11 years, P = 0.001), with no significant change for adults (P = 0.13). Prioritizing national sharing of all younger than 35-year-old deceased donor livers with children and Status 1A adults (SharePeds 2) would decrease waitlist deaths for infants, children, and all Status 1A/B patients (P < 0.0001 for each). SharePeds 1 and 2 would increase the number of liver transplants done in infants, children, and adolescents compared to the OPTN-2017 schema (P < 0.00005 for all age groups). Both SharePeds schema would increase the percentage of pediatric livers transplanted into pediatric recipients.

CONCLUSIONS:

Waitlist deaths could be significantly decreased, and liver transplants increased, for children and the sickest adults, by prioritizing children for pediatric livers and with broader national sharing of deceased donor livers.

PMID:
30720563
PMCID:
PMC6428603
[Available on 2020-04-01]
DOI:
10.1097/MPG.0000000000002287

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