Abstract:Information about wait‐list time has been reported as one of the single most frequently asked questions by individuals awaiting a transplant but data regarding wait‐list time have not been processed in a useful way for pediatric candidates. To predict chance of receiving a DDLT, we identified 6471 pediatric (<18 years), non status‐1A, liver‐only transplant candidates between 2006 and 2017 from the SRTR. Cox regression with shared frailty for DSA level effect was used to model the association of blood type, wei… Show more
“…In our cohort, the median waitlist time for the pediatric recipients was 89 (64-114) days, shorter than previously reported national waitlist times (100 [34-309] days). 23 The same trend was seen for adult recipients as well, with reduced waitlist times than previous reports. 24 However, despite these known benefits, SLT underutilization resides in big part on the high demanding logistics.…”
Section: A Recent Analysis Of the Scientific Registry Of Transplantsupporting
confidence: 77%
“…The positive effect on reduction of waitlist time and increase in organ pool by using split livers is evident. In our cohort, the median waitlist time for the pediatric recipients was 89 (64 –114) days, shorter than previously reported national waitlist times (100 [34–309] days) 23 . The same trend was seen for adult recipients as well, with reduced waitlist times than previous reports 24 .…”
Section: Discussionsupporting
confidence: 66%
“…Median follow-up for the entire cohort was 721 (247-1293.5) days, 736 days among adult recipients and 629 (306-1095) days among pediatric recipients. Median length of stay was 7 (5.5-10) days in adult recipients, and 24(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) days in pediatric recipients. After surgery, the parameters of liver function improved in all patients as expected.…”
Background
Split liver transplantation (SLT) is a strategy to address organ shortage, but is a technically more demanding procedure than whole graft liver transplantation (LT). We aimed to determine the outcomes following SLT in adult recipients as well as to highlight the impact that having a pediatric LT program has on SLT implementation.
Methods
All SLTs conducted at a single‐center from 2010 to 2019 were identified. Patient data was obtained through retrospective review of the electronic medical record. Kaplan–Meier analysis assessed primary outcomes of 1‐,3‐, and 5‐year graft and patient survival.
Results
We identified 37 SLTs performed at our institution from 2010 to 2019. Twenty‐four donated livers resulted in 21 extended right lobes and 16 left lateral segments for adults and pediatrics recipients, respectively. Eighty‐one percent (30/37) of the SLTs were performed after introduction of the combined pediatric program in 2016. 13/24 donor livers were split with both grafts allocated and used at our institution and 92% occurred after introduction of the pediatric program. Graft survival rates at 1‐, 3‐, and 5‐years were 94% in adult recipients and 100% for all time periods in pediatric recipients. Actuarial post‐transplant patient survival was 100% at 1‐, 3‐, and 5‐years in both.
Conclusions
The introduction of a pediatric liver transplantation program resulted in more than a fourfold increase in the number of SLTs performed at our center. Increase in allocation and use of both grafts at our institution was also seen.
“…In our cohort, the median waitlist time for the pediatric recipients was 89 (64-114) days, shorter than previously reported national waitlist times (100 [34-309] days). 23 The same trend was seen for adult recipients as well, with reduced waitlist times than previous reports. 24 However, despite these known benefits, SLT underutilization resides in big part on the high demanding logistics.…”
Section: A Recent Analysis Of the Scientific Registry Of Transplantsupporting
confidence: 77%
“…The positive effect on reduction of waitlist time and increase in organ pool by using split livers is evident. In our cohort, the median waitlist time for the pediatric recipients was 89 (64–114) days, shorter than previously reported national waitlist times (100 [34–309] days) 23 . The same trend was seen for adult recipients as well, with reduced waitlist times than previous reports 24 .…”
Section: Discussionsupporting
confidence: 66%
“…Median follow-up for the entire cohort was 721 (247-1293.5) days, 736 days among adult recipients and 629 (306-1095) days among pediatric recipients. Median length of stay was 7 (5.5-10) days in adult recipients, and 24(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) days in pediatric recipients. After surgery, the parameters of liver function improved in all patients as expected.…”
Background
Split liver transplantation (SLT) is a strategy to address organ shortage, but is a technically more demanding procedure than whole graft liver transplantation (LT). We aimed to determine the outcomes following SLT in adult recipients as well as to highlight the impact that having a pediatric LT program has on SLT implementation.
Methods
All SLTs conducted at a single‐center from 2010 to 2019 were identified. Patient data was obtained through retrospective review of the electronic medical record. Kaplan–Meier analysis assessed primary outcomes of 1‐,3‐, and 5‐year graft and patient survival.
Results
We identified 37 SLTs performed at our institution from 2010 to 2019. Twenty‐four donated livers resulted in 21 extended right lobes and 16 left lateral segments for adults and pediatrics recipients, respectively. Eighty‐one percent (30/37) of the SLTs were performed after introduction of the combined pediatric program in 2016. 13/24 donor livers were split with both grafts allocated and used at our institution and 92% occurred after introduction of the pediatric program. Graft survival rates at 1‐, 3‐, and 5‐years were 94% in adult recipients and 100% for all time periods in pediatric recipients. Actuarial post‐transplant patient survival was 100% at 1‐, 3‐, and 5‐years in both.
Conclusions
The introduction of a pediatric liver transplantation program resulted in more than a fourfold increase in the number of SLTs performed at our center. Increase in allocation and use of both grafts at our institution was also seen.
“…49 In the United States, pediatric waitlist mortality is reported to be around 8%-12% per year with a median waiting time of 100 d, with patients <1 y of age experiencing a disproportionately high rate of morbidity and mortality. [49][50][51] Although splitting a deceased donor liver can improve access to size-matched allografts for pediatric candidates, 2 recent analyses of US data illustrated that only a small percentage ranging from 3.4% to 3.8% of "splittable" deceased donor grafts were actually split. 3,52 Even with new allocation policies, the logistics of having a procurement surgeon with appropriate technical expertise, performing technically demanding surgery at offsite facilities, and appropriately allocating the remaining right trisegment graft are all major barriers in practice.…”
OBJECTIVES:
Progress in pediatric transplantation measured in the context of waitlist and posttransplant survival is well documented but falls short of providing a complete perspective for children and their families. An intent-to-treat analysis, in which we measure survival from listing to death regardless of whether a transplant is received, provides a more comprehensive perspective through which progress can be examined.
METHODS:
Univariable and multivariable Cox regression was used to analyze factors impacting intent-to-treat survival in 12 984 children listed for heart transplant, 17 519 children listed for liver transplant, and 16 699 children listed for kidney transplant. The Kaplan-Meier method and log-rank test were used to assess change in waitlist, posttransplant, and intent-to-treat survival. Wait times and transplant rates were compared by using χ2 tests.
RESULTS:
Intent-to-treat survival steadily improved from 1987 to 2017 in children listed for heart (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.96–0.97), liver (HR 0.95, 95% CI 0.94–0.97), and kidney (HR 0.97, 95% CI 0.95–0.99) transplant. Waitlist and posttransplant survival also improved steadily for all 3 organs. For heart transplant, the percentage of patients transplanted within 1 year significantly increased from 1987 to 2017 (60.8% vs 68.7%); however, no significant increase was observed in liver (68.9% vs 72.5%) or kidney (59.2% vs 62.7%) transplant.
CONCLUSIONS:
Intent-to-treat survival, which is more representative of the patient perspective than individual metrics alone, steadily improved for heart, liver, and kidney transplant over the study period. Further efforts to maximize the donor pool, improve posttransplant outcomes, and optimize patient care while on the waitlist may contribute to future progress.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.