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Utilization of Segmental Grafts Is Associated With Higher Transplant Rates in Pediatric Patients
Fidel Lopez-Verdugo1, Jorge Sanchez-Garcia1, Shanni Baraki2
1Liver Center, Primary Children's Hospital, Salt Lake City, Utah; Transplant Services, Intermountain Medical Center, Salt Lake City, Utah.
Insights
Implementing a policy to increase segmental grafts (SGs) significantly boosted liver transplant (LT) rates and reduced waiting times for pediatric patients. This change improved transplant activity without negatively impacting patient or graft survival.
Area of Science:
- Pediatric surgery
- Transplant surgery
- Organ transplantation
Background:
- A policy change in July 2017 aimed to increase the utilization of segmental grafts (SGs) in liver transplantation (LT).
- The study evaluated the impact of this policy on pediatric liver waiting list activity.
Purpose of the Study:
- To compare changes in liver transplant waitlist activity after the implementation of a policy promoting segmental graft use.
- To assess the effect of increased SG utilization on transplant rates and waiting times in pediatric patients.
Main Methods:
- A retrospective, single-center study analyzed pediatric patients on the liver waiting list from January 2015 to December 2019.
- Patients were divided into two groups: those receiving LT before (Period 1) and after (Period 2) the policy implementation.
- Primary endpoints included transplant rates and time to transplant, with survival rates also analyzed.
Main Results:
- The proportion of SGs used for LT increased from 10.3% in Period 1 to 55% in Period 2 (P < 0.001).
- Transplant rates per 100 person-years on the waiting list rose from 85.09 to 187.87 (Rate ratio: 2.20; P < 0.001).
- Median time to LT decreased significantly from 229 days to 75 days (P = 0.013), with no significant difference in patient or graft survival rates.
Conclusions:
- The policy to increase SG use was associated with significantly higher transplant rates and reduced waiting times.
- Successful implementation of the SG policy did not negatively affect patient or graft survival.
- Increased use of segmental grafts can improve efficiency in pediatric liver transplant programs.
Introduction:
In July 2017, a policy to increase the use of segmental grafts (SGs) was implemented at our institution. The aim was to compare changes in waitlist activity after implementation of this policy.
Methods:
A single-center, retrospective study. Pediatric patients on the liver waiting list between January 2015 and December 2019 were screened. Patients were classified as receiving a liver transplant (LT) before (Period 1) or after (Period 2) policy changes. Primary end points were transplant rates and time to transplant.
Results:
Sixty five first LT performed on 65 patients were included. Twenty nine LT were performed during Period 1 and 36 during Period 2. More than half (55%) of LT in Period 2 were SG, compared to 10.3% in Period 1 (P < 0.001). Forty nine and 56 pediatric candidates on the waiting list accounted for 38.78 and 24.48 person-years during Period 1 and Period 2, respectively. Transplant rates per 100 person-years on the waiting list increased from 85.09 during Period 1 to 187.87 in Period 2 (Rate ratio: 2.20; P < 0.001). Median time to receive a LT decreased from 229 d in Period 1 to 75 d during Period 2 (P = 0.013). One-year patient survival rates were 96.6% in Period 1 and 95.7% in Period 2. One-year graft survival rates were 89.7% and 88% in Period 1 and Period 2, respectively.
Conclusions:
A policy to increase the use of SG was associated with significantly higher transplant rates and lower waiting times. Implementation of this policy can be done successfully with no observed negative impact on patient and graft survival.
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