Do smaller adults wait longer for liver transplantation? A comparison of the UK and the USA data

Young, Alastair L.; Peters, Christopher J.; Pocock, Phil; Millson, C; Prasad, Kondapalli Siva

doi:10.1111/j.1399-0012.2009.01037.x

Cited by 5 publications

(14 citation statements)

References 20 publications

(18 reference statements)

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“…In pediatric liver transplant centers, where the need for small donors is even higher, split liver transplantation procedures may be performed more often, resulting in higher allocation rates for small adults in these centers. 1,8 Allocation rates for small adults may be improved by the use of an intention to split policy for a pediatric and adult recipient or by full-left, full-right split liver transplantation for 2 adult recipients. 8,9,11,12 However, splitting a liver into an extended right lobe and a left lateral lobe may not necessarily benefit small adults.…”

Section: Discussionmentioning

confidence: 99%

“…Listing small adults in pediatric transplant centers may improve allocation rates, as these centers are more familiar with split liver procedure. 1 Considering increasing obesity rates in all Western countries, the pool of small donors is unlikely to increase. 5 Therefore, small adults may be increasingly disadvantaged for receiving a size-matched whole liver graft.…”

Section: Discussionmentioning

confidence: 99%

“…The shortage of suitable donor livers for this patient group may result in increased waiting times, waitlist removal, mortality, and decreased access to transplantation as compared to larger adult patients. 1 In the Netherlands and the Eurotransplant region, the model for end-stage liver disease (MELD) allocation system was implemented in 2006. In this system, donor livers are allocated according to recipient need.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] A previous study based on the data from the UK and the United States reported increased waiting times for small adults in adult-only centers. 1 In pediatric centers, the use of a left lateral graft for a child and an extended right graft for an adult has proven to reduce the waitlist mortality of children. 1,8 Full-left and full-right liver transplantation for 2 adults or living donor liver transplantation may be additional options.…”

Section: Introductionmentioning

confidence: 99%

“…1 In pediatric centers, the use of a left lateral graft for a child and an extended right graft for an adult has proven to reduce the waitlist mortality of children. 1,8 Full-left and full-right liver transplantation for 2 adults or living donor liver transplantation may be additional options. 9,10 No previous study evaluated allocation rates for adults with lower bodyweight in the Eurotransplant region.…”

Section: Introductionmentioning

confidence: 99%

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Disadvantage of Small (<60 kg) Adult Candidates on the Liver Transplantation Waitlist

et al. 2020

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Background: Small adult patients with lower bodyweight wait-listed for liver transplantation may face a shortage of size-matched whole-liver grafts. The objective of this study is to compare time to transplantation in adult patients with a bodyweight of <60 kg to patients with bodyweight ≥60 kg. Methods: A matched case–control study was conducted. Patients aged 18 years and older listed for liver transplantation at our transplant center, from 2007 to 2016 with a bodyweight <60 kg were manually matched 1:2 to control patients ≥ 60 kg. Matching was performed based on ABO blood type, model for end-stage liver disease score, (non)-standard exception status, and eligibility for donation after cardiac death. Time to transplantation was assessed with univariable Cox-regression. Results: In total, 23 cases with a bodyweight < 60 kg were matched to 46 average-sized control patients. Small adults were significantly disadvantaged for receiving a liver transplantation as compared to their average-sized counterpart (hazard ratio 0.47; 95% confidence interval 0.29-0.75, P = .002). At the end of follow-up, 14/23 (60.9%) of cases versus 35/46 of controls (76.1%) had received a liver transplantation. Conclusion: Small adults with a bodyweight below 60 kg are disadvantaged on the waitlist for a size-matched whole liver graft.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disadvantage of Small (<60 kg) Adult Candidates on the Liver Transplantation Waitlist

et al. 2020

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A Prospective Policy Development to Increase Split-Liver Transplantation for 2 Adult Recipients

Aseni¹,

Feo²,

Carlis³

et al. 2014

Annals of Surgery

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Quantifying the Disadvantage of Small Recipient Size on the Liver Transplantation Waitlist, a Longitudinal Analysis Within the Eurotransplant Region

Sneiders,

van Dijk,

Darwish-Murad

et al. 2023

Transplantation

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Background. Small adult patients with end-stage liver disease waitlisted for liver transplantation may face a shortage of size-matched liver grafts. This may result in longer waiting times, increased waitlist removal, and waitlist mortality. This study aims to assess access to transplantation in transplant candidates with below-average bodyweight throughout the Eurotransplant region. Methods. Patients above 16 y of age listed for liver transplantation between 2010 and 2015 within the Eurotransplant region were eligible for inclusion. The effect of bodyweight on chances of receiving a liver graft was studied in a Cox model corrected for lab-Model for End-stage Liver Disease (MELD) score updates fitted as time-dependent variable, blood type, listing for malignant disease, and age. A natural spline with 3 degrees of freedom was used for bodyweight and lab-MELD score to correct for nonlinear effects. Results. At the end of follow-up, the percentage of transplanted, delisted, and deceased waitlisted patients was 49.1%, 17.9%, and 24.3% for patients with a bodyweight <60 kg (n = 1267) versus 60.1%, 15.1%, and 18.6% for patients with a bodyweight ≥60 kg (n = 10 520). To reach comparable chances for transplantation, 60-kg and 50-kg transplant candidates are estimated to need, respectively, up to 2.8 and 4.0 more lab-MELD points than 80-kg transplant candidates. Conclusions. Decreasing bodyweight was significantly associated with decreased chances to receive a liver graft. This resulted in substantially longer waiting times, higher delisting rates, and higher waitlist mortality for patients with a bodyweight <60 kg.

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Do smaller adults wait longer for liver transplantation? A comparison of the UK and the USA data

Cited by 5 publications

References 20 publications

Disadvantage of Small (<60 kg) Adult Candidates on the Liver Transplantation Waitlist

Disadvantage of Small (<60 kg) Adult Candidates on the Liver Transplantation Waitlist

A Prospective Policy Development to Increase Split-Liver Transplantation for 2 Adult Recipients

Quantifying the Disadvantage of Small Recipient Size on the Liver Transplantation Waitlist, a Longitudinal Analysis Within the Eurotransplant Region

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