Index to Predict Waiting Times for Pediatric Liver Transplantation

Area of Science:

• Hepatology
• Transplant Surgery
• Pediatric Medicine

Background:

• Liver transplant wait times for pediatric candidates are uncertain.
• Identifying factors influencing wait times is critical for patient management.
• A predictive tool can improve decision-making for pediatric liver transplant candidates.

Purpose of the Study:

• To identify variables associated with pediatric liver transplant wait times.
• To develop a predictive points score for deceased-donor liver transplant likelihood within one year.
• To enhance clinical decision-making for pediatric liver transplant candidates.

Main Methods:

• Retrospective analysis of 5246 pediatric liver transplant candidates (2014-2024) using OPTN/UNOS data.
• Univariate and multivariate logistic regression to analyze demographic, lab, and medical history variables.
• Development of a weighted points system based on significant predictors and ROC analysis for model performance.

Main Results:

• Nineteen variables were statistically significant predictors of transplant likelihood.
• Factors positively associated with transplant include high/medium volume transplant center and Pacific Islander race.
• Factors negatively associated include serum sodium >150 mEq/L, acute hepatic necrosis, and bilirubin 1-2 mg/dL.

Conclusions:

• Key predictors of pediatric liver transplant wait time have been identified.
• A novel predictive scoring system can improve clinical decision-making for transplant candidates.
• This tool aids in identifying vulnerable candidates and exploring alternative transplant options.