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Functional status at listing predicts waitlist and posttransplant mortality in pediatric liver transplant candidates

Emily R Perito1,2, John Bucuvalas3, Jennifer C Lai4

  • 1Department of Pediatrics, UCSF, San Francisco, California.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|December 4, 2018
PubMed

Insights

Functional impairment in pediatric liver transplant candidates significantly increases mortality risk. Assessing functional status using the Lansky Play-Performance Scale (LPPS) is crucial for predicting outcomes and prioritizing care.

Area of Science:

  • Pediatric Hepatology
  • Transplant Surgery
  • Clinical Outcomes Research

Background:

  • Functional impairment is a known predictor of mortality in adult liver transplant candidates.
  • Limited data exists on the impact of functional status on pediatric liver transplant candidates' outcomes.
  • The Lansky Play-Performance Scale (LPPS) is used to assess functional status in pediatric patients.

Purpose of the Study:

  • To investigate the association between functional status and waitlist mortality in pediatric liver transplant candidates.
  • To evaluate the impact of functional status on post-transplant mortality and graft loss in children.
  • To determine if functional status is an independent predictor of outcomes in pediatric liver transplantation.

Main Methods:

  • Utilized United Network for Organ Sharing Standard Transplant Analysis and Research (STAR) files.
  • Analyzed data from pediatric liver transplant candidates (under 18 years) waitlisted between 2006-2016.
  • Categorized functional status using the Lansky Play-Performance Scale (LPPS): normal/good (80-100), moderately impaired (50-70), and severely impaired (10-40).

Main Results:

  • Children with severely impaired functional status (LPPS 10-40) had a significantly higher risk of waitlist mortality (HR 1.85).
  • Severely impaired functional status (LPPS 10-40) drastically increased 1-year post-transplant mortality risk (HR 5.77).
  • Both moderately (50-70) and severely (10-40) impaired LPPS scores increased the risk of 1-year graft loss.

Conclusions:

  • Functional status is an independent predictor of both waitlist and post-transplant mortality in pediatric liver transplant candidates.
  • Accurate assessment of functional status is vital for predicting mortality risk and prioritizing pediatric patients for liver transplantation.
  • Validated tools for functional status assessment in this population could improve transplant allocation and patient management.

Keywords:
United Network for Organ Sharing (UNOS)clinical research/practicehealth services and outcomes researchliver allograft function/dysfunctionliver transplantation/hepatologyorgan allocationpediatricswaitlist management

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