The Landscape of Status 1B by Exception for Pediatric Acute on Chronic Liver Failure-High Risk, High Mortality, and Low Transplant Rate
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View abstract on PubMed
Summary
This summary is machine-generated.One-third of children with acute on chronic liver failure (ACLF) receive Status 1B liver transplant listing via exception. These children had similar outcomes to those listed by explicit criteria, suggesting a need for further research.
Area Of Science
- Pediatric Hepatology
- Transplantation Immunology
- Critical Care Medicine
Background
- Acute on chronic liver failure (ACLF) is a severe condition associated with high mortality due to multiorgan failure.
- Liver transplantation (LT) is a critical intervention for children with ACLF.
Purpose Of The Study
- To compare the characteristics and outcomes of children with ACLF listed for LT under Status 1B using explicit criteria versus exception criteria.
- To investigate regional variations in the utilization of exception criteria for listing children with ACLF.
Main Methods
- Retrospective analysis of 367 children with ACLF listed as Status 1B for LT between 2007 and 2019 from the United Network for Organ Sharing (UNOS) database.
- Exclusion of children with metabolic diseases and malignancies.
- Comparison of demographic data, organ failure incidence, MELD/PELD scores, transplantation rates, and pre-/post-LT mortality between explicit and exception listing groups.
Main Results
- 30% (110/367) of children with ACLF were listed under exception criteria.
- No significant differences in age, sex, race/ethnicity, or diagnosis between the groups.
- Exception group had lower incidence of organ failures and MELD/PELD scores at listing and removal, but similar transplantation rates and pre-/post-LT mortality.
- Regional disparities in exception listing utilization were observed, with higher rates in regions 2 and 10.
- Reasons for exception listing included critical illness and high risk of waitlist mortality.
Conclusions
- Approximately one-third of children with ACLF listed as Status 1B for LT utilize exception criteria.
- Children listed by exception demonstrated comparable pre- and post-transplant mortality to those listed by explicit criteria.
- Further investigation is warranted to elucidate the specific factors contributing to the heightened risk in children listed by exception.
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