Background & Aims

Approximately 10% of children on the liver transplant wait-list in the United States die every year. We examined deceased donor liver offer acceptance patterns and their contribution to pediatric wait-list mortality.

Methods

We performed a retrospective cohort study of children on the US liver transplant wait-list from 2007 through 2014 using national transplant registry databases. We 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. Children who died or were delisted were classified by the number of donor liver offers (0 vs 1 or more), limiting analyses to offers of livers that were ultimately transplanted into pediatric recipients. The primary outcome was death or delisting on the wait-list.

Results

Among 3852 pediatric liver transplant candidates, children who died or were delisted received a median 1 pediatric liver offer (inter-quartile range, 0–2) and waited a median 33 days before removal from the wait-list. Of 11,328 donor livers offered to children, 2533 (12%) were transplanted into children; 1179 of these (47%) were immediately accepted and 1354 (53%) were initially refused and eventually accepted for another child. Of 27,831 adults, 1667 (6.0%; median, 55 years) received livers from donors younger than 18 years (median, 15 years), most (97%) allocated locally or regionally. Of children who died or were delisted, 173 (55%) received an offer of 1 or more liver that was subsequently transplanted into another pediatric recipient, and 143 (45%) died or were delisted with no offers.

Conclusions

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.

中文翻译：

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移植等待名单上对小儿肝病的报价分析

背景与目标

在美国，每年大约有10％的肝移植等待名单上的儿童死亡。我们检查了已故的供体肝脏提供的接受模式及其对小儿等待名单死亡率的影响。

方法

我们使用国家移植注册数据库对2007年至2014年美国肝移植候补名单上的儿童进行了一项回顾性队列研究。我们确定了死亡或除名的儿童与接受移植的儿童相比，捐赠者的肝脏器官供体死亡的频率，接受方式以及捐赠者和接受者的特征。死亡或被除名的儿童按供体肝脏供血数量进行分类（0比1或更多），从而将分析仅限于最终移植到小儿接受者的肝脏供血。主要结果是死亡或从等待名单上除名。

结果

在3852例小儿肝移植候选者中，死亡或退名的儿童获得了中位数1的小儿肝供体（四分位数范围为0–2），并且等待了中位数33天才从等待名单中删除。在向儿童提供的11328例供体肝中，有2533例（12％）被移植到了儿童中；其中的1179个（占47％）被立即接受，最初的1354个（占53％）被拒绝，并最终被另一个孩子接受。在27,831名成年人中，有1667名（6.0％；中位年龄为55岁）从18岁以下（中位年龄为15岁）的捐助者那里接受了肝脏，其中大部分（97％）是从本地或区域分配的。在死亡或除名的儿童中，有173名（55％）接受了一份或多于一种肝脏的要约，随后将其移植到另一名儿科接受者中；有143名（45％）的死亡或被除名了，但没有要约。

结论

在美国的小儿肝移植候选人中，死亡或被除名的儿童获得了中位数1个小儿肝脏的报价，并等待了33天。在移植到儿童中的肝脏中，有47％立即被接受，而53％最初被拒绝并最终被另一个孩子接受。在死亡或被除名的儿童中，有55％接受了一份或多于一份肝脏的要约，该要约随后被移植到另一位儿科接受者中，而45％的死亡或被除名的则没有要约。为了降低儿童的等待名单死亡率，需要在分配和发展改进的风险分层系统中对儿童进行优先排序。