State of pediatric liver transplantation in the United States and achieving zero wait list mortality with ideal outcomes: A statement from the Starzl Network for Excellence in Pediatric Transplant Surgeon's Working Group

Abstract

Background Liver transplant is a life‐saving therapy that can restore quality life for several pediatric liver diseases. However, it is not available to all children who need one. Expertise in medical and surgical management is heterogeneous, and allocation policies are not optimally serving children. Technical variant grafts from both living and deceased donors are underutilized. Methods Several national efforts in pediatric liver transplant to improve access to and outcomes from liver transplant for children have been instituted and include adjustments to allocation policies, UNOS‐sponsored collaborative improvement projects, and the emergence of national learning networks to study ongoing challenges in the field the Surgical Working group of the Starzl Network for Excellence in Pediatric Transplantation (SNEPT) discusses key issues and proposes potential solutions to eliminate the persistent wait list mortality that pediatric patients face. Results A discussion of the factors impacting pediatric patients’ access to liver transplant is undertaken, along with a proposal of several measures to ensure equitable access to life‐saving liver transplant. Conclusions Pediatric liver transplant wait list mortality can and should be eliminated. Several measures, including collaborative efforts among centers, could be leveraged to acheive this goal.

Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting

“…Potential options for increasing the number of surgeons and programs with LDLT and other TVG capabilities are illustrated in Figure 1. 6 improve outcomes. 7,8 Pediatric LD recipients have better graft and patient survival than deceased donor recipients.…”

“…Potential options for increasing the number of surgeons and programs with LDLT and other TVG capabilities are illustrated in Figure 1. 6…”

“…Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting Amy G. Feldman, MD, MSCS, 1 Megan Adams, MD, 2 Adam D. Griesemer, MD, 3 Simon Horslen, MB, ChB, FRCPCH, 4 Beau Kelly, MD, MBA, FACS, FAST, 5 Alisha M. Mavis, MD, 6 George V. Mazariegos, MD, 7 Vicky L. Ng, MD, FRCPC, 8 Emily R. Perito, MD, MAS, 9 Manuel I. Rodriguez-Davalos, MD, FACS, 10 James E. Squires, MD, MS, 4 Greg Tiao, MD, 11 George S. Yanni, MD, FAASLD, 12 and Evelyn K. Hsu, MD 13 T he Society of Pediatric Liver Transplantation (SPLIT) has grown into a community of over 40 centers with synergistic platforms in research, education, advocacy, quality improvement, and clinical care. In 2019, SPLIT joined forces with the Transplantation Society in a mission to improve the lives of children who require (and undergo) liver transplantation (LT).…”

Insufficient use of technical variant grafts: An unfulfilled promise in pediatric liver transplantation

“…[3] These important data should galvanize the pediatric liver community as they further underscore that establishing the availability of TVGs as a standard of care for all pediatric LT recipients is an important component in moving toward the goal of zero WL mortality. [11] CONFLICTS OF INTEREST…”

Offering children the best organs to optimize transplantation outcomes

“…Despite significant advances in the field of pediatric liver transplantation, unacceptable waitlist mortality persists. Rasmussen et al 5 present the report of the Surgical Working Group of the Starzl Network for Excellence in Pediatric Transplantation. They discuss the key factors that impact the pediatric liver transplant candidate's access to transplant and propose measures to help the community achieve the goal of zero waitlist mortality with ideal outcomes.…”