Chang CCH, et al. – In this retrospective analysis of 4,4298 patients with chronic liver diseases (aged <18 years) identified using the United Network for Organ Sharing (UNOS) pediatric waiting list, researchers assessed the accuracy of the Pediatric End-stage Liver Disease (PELD) score in estimating 90-day pretransplant mortality among pediatric patients on the UNOS waiting list. Results indicated that the ranking of risk among children was preserved with the use of the PELD score. However, direct comparisons between adult and pediatric candidates were not accurate. The researchers concluded that, compared with adults in a similar situation, children with the chronic liver disease who need a transplant may be at a disadvantage.

Methods

• Patients (aged <18 years) with chronic liver disease who were listed from February 27, 2002, to March 31, 2014, for primary liver transplant were enrolled and followed up for at least 2 years through June 17, 2016.
• Using the UNOS Standard Transplant Analysis and Research data files, the study analyzed two cohorts: the full cohort (n=4,298), which excluded participants with cancer, and the reduced cohort (n=2,421), which excluded participants receiving living donor transplantation or PELD exception points.
• Observed and expected 90-day pretransplant mortality rates evaluated at 10-point interval PELD levels were the main outcomes and measures analyzed.

Results

• The study results showed that PELD scores and mortality were concordant (C statistic, 0.8387 [95% CI: 0.8191-0.8584] for the full cohort and 0.8123 [95% CI: 0.7919-0.8327] for the reduced cohort) among the 4,298 participants in the full cohort (mean [standard deviation] age, 2.5 [4.2] years; 2,251 [52.4%] female; 2,201 [51.2%] white).
• Results that the estimated 90-day mortality using the PELD score underestimated the actual probability of death by as much as 17%.