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Mortality Determinants in Children with Biliary Atresia Awaiting Liver Transplantation
Ioannis A Ziogas1, Fei Ye2, Zhiguo Zhao2
1Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN.
Insights
High bilirubin, portal vein thrombosis, and ventilator dependence increase waitlist mortality risk in children with biliary atresia awaiting liver transplants. Heavier weight at listing is protective.
Area of Science:
- Pediatric Hepatology
- Transplantation Surgery
- Gastroenterology
Background:
- Biliary atresia is a leading indication for pediatric liver transplantation.
- Identifying risk factors for waitlist mortality is crucial for optimizing transplant allocation.
Purpose of the Study:
- To determine risk factors associated with waitlist mortality in children with biliary atresia listed for liver transplantation.
Main Methods:
- Utilized the United Network for Organ Sharing database (2002-2018) including 2704 children (<12 years) listed for a first liver transplant.
- Employed Fine-Gray regression models for competing risks analysis to identify risk factors for waitlist mortality.
Main Results:
- Cumulative incidence of waitlist mortality was 5.2%.
- Increased bilirubin levels, portal vein thrombosis, and ventilator dependence at listing were associated with higher waitlist mortality risk.
- Weight ≥10 kg at listing was associated with a lower risk; ascites also increased risk.
Conclusions:
- Identified key clinical parameters at listing that predict waitlist mortality in pediatric biliary atresia patients.
- These factors can aid in objective prioritization for liver transplantation and identify high-risk individuals.
Objective:
To determine risk factors for waitlist mortality in children with biliary atresia listed for liver transplantation.
Study Design:
There were 2704 children with biliary atresia (<12 years of age) listed for a first liver transplant (2002-2018) in the United Network for Organ Sharing database. Fine-Gray regression models for competing risks analysis (main risk = waitlist mortality/delisting owing to too sick; competing risk = liver transplantation) were implemented to identify risk factors for waitlist mortality.
Results:
The median waitlist time was 83 days (IQR, 34-191). The cumulative incidence of waitlist mortality was 5.2%. In multivariable analysis (n = 2253), increasing bilirubin level (P < .001), portal vein thrombosis (P = .03), and ventilator dependence (P < .001) at listing were associated with a higher risk, whereas weight ≥10 kg at listing (P = .009) was associated with a lower risk of waitlist mortality. When ascites at listing was included in multivariable analysis (n = 1376), it was associated with a higher risk for the composite outcome (P = .03). Encephalopathy at listing was not associated with waitlist mortality (n = 1376; P = .15).
Conclusions:
These parameters can be used to more objectively prioritize children with biliary atresia awaiting liver transplantation and identify children with biliary atresia-related end-stage liver disease at high-risk of mortality.
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