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Updated: Aug 6, 2026
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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Inequality in Pediatric Liver Transplantation
Ahmad Anouti1, Lauren E Matevish2, Pojsakorn Danpanichkul3
1Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas.
Pediatrics
|July 22, 2026
Summary
Pediatric liver transplant (LT) activity is concentrated in high-volume centers, leading to significant access disparities. Many centers exhibit pseudo-access, highlighting the need for reforms to improve organ allocation and transplant rates.
Area of Science:
- Transplant Surgery
- Pediatric Hepatology
- Organ Allocation Policy
Background:
- Persistent disparities in pediatric liver transplant (LT) access exist across transplant centers.
- Understanding the drivers of these inequities is crucial for optimizing organ utilization and preventing pseudo-access.
Purpose of the Study:
- To evaluate center-level variations in donor organ use, offer acceptance practices, and transplant rates in pediatric LT.
- To quantify the extent of access inequality among US pediatric LT centers.
Main Methods:
- Cross-sectional analysis of US pediatric LT centers using Scientific Registry of Transplant Recipients data (2023-2024).
- Centers were stratified by volume (quartiles), and metrics like acceptance intensity and transplant rate ratios (TRRs) were assessed.
- Gini coefficients were used to quantify inequality in access.
Main Results:
- Significant variation in center volume and new listings was observed.
- Lower transplant rates and higher mortality were noted in lower-volume centers (Q1) compared to high-volume centers (Q4).
- Four center types were identified, with 'aggressive utilizers' showing highest acceptance and TRRs; significant inequality was demonstrated by Gini coefficients.
Conclusions:
- Pediatric LT activity is highly concentrated in a few centers, indicating significant inequality.
- Pseudo-access is prevalent, characterized by low acceptance and transplant rates despite active listings.
- Structural and process-level reforms are necessary to address these disparities in pediatric liver transplantation.
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