Waiting List Survival After Pediatric Liver Transplant Emergent Relisting

Area of Science:

• Pediatric Hepatology
• Transplantation Medicine
• Organ Donation and Transplantation

Background:

• Outcomes for children relisted as status 1/1A after pediatric liver transplantation are not well-documented.
• This study addresses the need for updated information on waiting list survival in this critical patient group.

Purpose of the Study:

• To describe waiting list survival to retransplantation or graft recovery in children relisted as status 1/1A.
• To identify factors associated with waiting list dropout and recovery in this population.

Main Methods:

• Retrospective review of the United Network for Organ Sharing liver database for children relisted as status 1/1A (March 2002–June 2022).
• Logistic regression analysis to determine factors influencing waiting list dropout and recovery.

Main Results:

• Of 679 relisted candidates, 15% experienced dropout, 57% were retransplanted, and 28% recovered without retransplant.
• Factors increasing dropout risk included portal vein thrombosis, higher MELD/PELD score, higher creatinine, and mechanical ventilation at original transplant; non-Hispanic White race/ethnicity was protective.
• Mechanical ventilation and portal vein thrombosis at relisting were associated with lower odds of recovery.

Conclusions:

• Findings underscore the need for improved waiting list survival strategies and policy adjustments for pediatric liver transplant recipients.
• Portal vein thrombosis is a significant risk factor for both dropout and reduced recovery, necessitating prompt retransplantation consideration for status 1A patients.