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Pediatric discard risk index for predicting pediatric liver allograft discard

Tahir Malik1, Manasi Joshi1, Elizabeth Godfrey1

  • 1Department of Surgery, Baylor College of Medicine, Houston, TX, USA.

Pediatric Transplantation
|January 6, 2021
PubMed

Insights

A new pediatric discard risk score (pDSRI) predicts liver allograft discard using 11 factors, aiming to reduce waste and optimize donor supply for children awaiting transplants.

Area of Science:

  • Organ transplantation
  • Pediatric hepatology
  • Transplant immunology

Background:

  • Annually, 600 pediatric candidates are listed for liver transplants, with 100 remaining on the waiting list.
  • Over 100 pediatric liver allografts are discarded yearly, frequently due to subjective assessments.
  • This represents a significant loss of viable organs and a challenge in optimizing donor supply.

Purpose of the Study:

  • To develop a predictive risk index for pediatric liver allograft discard.
  • To optimize the utilization of donor organs for pediatric liver transplantation.
  • To reduce the number of discarded liver allografts by providing objective discard criteria.

Main Methods:

  • Retrospective analysis of 17,367 deceased pediatric donors (≤18 years old) using the UNOS database.
  • Development of a risk index (pDSRI) through univariate and multivariate logistic regression models.
  • Identification of significant predictors of allograft discard based on clinical and laboratory data.

Main Results:

  • Eleven significant predictors of pediatric liver allograft discard were identified (P < .05).
  • Key risk factors included donation after cardiac death (DCD), total bilirubin >10 mg/dL, and alanine transaminase (ALT) ≥500 IU/L.
  • The pDSRI demonstrated strong predictive accuracy with a C-statistic of 0.846 (training) and 0.840 (validation).

Conclusions:

  • The pDSRI accurately predicts the risk of pediatric liver allograft discard.
  • This tool incorporates 11 significant risk factors, including liver function tests and donor characteristics.
  • The pDSRI can potentially maximize donor yield and improve organ allocation for pediatric liver transplantation.
Abstract

Keywords:
discardliver allograftsliver transplantmarginal allograftspediatric allograft discardwait list

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