Waiting List Survival After Pediatric Liver Transplant Emergent Relisting

Waiting list outcomes for children relisted as status 1/1A following pediatric liver transplantation are not well described in the modern era. The aim of this study was to describe waiting list survival to retransplantation or graft recovery in this population and identify factors associated with these outcomes.

The United Network for Organ Sharing liver database was retrospectively reviewed for all children re-listed as status 1/1A between March 1, 2002 and June 30, 2022. Logistic regression was performed for the outcomes of waiting list dropout and recovery.

679 candidates were relisted as status 1/1A. Ninety-nine (15%) candidates had waiting list dropout, 389 (57%) were retransplanted, and 191 (28%) recovered without retransplant. There was no significant difference in survival across the status 1 versus status 1A eras. In multivariable analysis, portal vein thrombosis, higher Model for End-stage Liver Disease/Pediatric End-Stage Liver Disease score and creatinine at relisting, and mechanical ventilation at original transplant were associated with increased odds for dropout, while non-Hispanic White race/ethnicity was protective against dropout. Mechanical ventilation and portal vein thrombosis at relisting were associated with lower odds of recovery.

Our findings highlight the need for further research and policy changes to improve waiting list survival for this patient population. Portal vein thrombosis is associated with both dropout and decreased odds of recovery and should prompt aggressive pursuit of retransplantation in recipients relisted as status 1A.