Douglas Mogul1, Emily R Perito2, Nicholas Wood3, George V Mazariegos4, Douglas VanDerwerken3, Samar H Ibrahim5, Saeed Mohammad6, Pamela L Valentino7, Sommer Gentry3, Evelyn Hsu8. 1. Department of Pediatrics, Johns Hopkins University, Baltimore, MD. 2. Department of Pediatrics, University of California San Francisco, San Francisco, CA. 3. Department of Mathematics, United States Naval Academy, Annapolis, MD. 4. Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. 5. Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 6. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 7. Section of Gastroenterology & Hepatology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 8. Department of Pediatrics, University of Washington, Seattle, WA.
Abstract
BACKGROUND: In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. METHODS: We applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes. Means from each allocation scheme were compared using matched-pairs t-tests. RESULTS: Over a 3-year period, AC allocation is projected to decrease waitlist deaths in infants (39 vs 55; P<0.001), children (32 vs 50; P<0.001), and teenagers (15 vs 25; P<0.001). AC allocation would increase the number of transplants in infants (707 vs 560; P<0.001), children (677 vs 547; P<0.001), and teenagers (404 vs 248; P<0.001). AC allocation led to decreased median PELD/MELD at transplant for infants (29 vs 30; P=0.01), children (26 vs 29; P<0.001), and teenagers (26 vs 31; P<0.001). Additionally, AC allocation would lead to fewer transplants in status 1B in children (97 vs 103; P=0.006) but not infants or teenagers. With AC allocation, 77% of pediatric donor organs would be allocated to pediatric candidates, compared to only 46% in DSA/Region-based allocation (P<0.001). CONCLUSION: AC allocation will likely address disparities for pediatric liver transplant candidates and recipients by increasing transplants and decreasing waitlist mortality. It is more consistent with federally-mandated requirements for organ allocation.
BACKGROUND: In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. METHODS: We applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes. Means from each allocation scheme were compared using matched-pairs t-tests. RESULTS: Over a 3-year period, AC allocation is projected to decrease waitlist deaths in infants (39 vs 55; P<0.001), children (32 vs 50; P<0.001), and teenagers (15 vs 25; P<0.001). AC allocation would increase the number of transplants in infants (707 vs 560; P<0.001), children (677 vs 547; P<0.001), and teenagers (404 vs 248; P<0.001). AC allocation led to decreased median PELD/MELD at transplant for infants (29 vs 30; P=0.01), children (26 vs 29; P<0.001), and teenagers (26 vs 31; P<0.001). Additionally, AC allocation would lead to fewer transplants in status 1B in children (97 vs 103; P=0.006) but not infants or teenagers. With AC allocation, 77% of pediatric donor organs would be allocated to pediatric candidates, compared to only 46% in DSA/Region-based allocation (P<0.001). CONCLUSION: AC allocation will likely address disparities for pediatric liver transplant candidates and recipients by increasing transplants and decreasing waitlist mortality. It is more consistent with federally-mandated requirements for organ allocation.
Authors: Mary G Bowring; Sheng Zhou; Eric K H Chow; Allan B Massie; Dorry L Segev; Sommer E Gentry Journal: Transplantation Date: 2019-10 Impact factor: 4.939
Authors: Pamela L Valentino; Sukru Emre; Gan Geliang; Luhang Li; Yanhong Deng; David Mulligan; Manuel I Rodriguez-Davalos Journal: Am J Transplant Date: 2019-06-24 Impact factor: 8.086
Authors: W R Kim; J R Lake; J M Smith; D P Schladt; M A Skeans; S M Noreen; A M Robinson; E Miller; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2019-02 Impact factor: 8.086
Authors: S E Gentry; A B Massie; S W Cheek; K L Lentine; E H Chow; C E Wickliffe; N Dzebashvili; P R Salvalaggio; M A Schnitzler; D A Axelrod; D L Segev Journal: Am J Transplant Date: 2013-07-09 Impact factor: 8.086
Authors: Kazunari Sasaki; Daniel J Firl; John C McVey; Jesse D Schold; Giuseppe Iuppa; Teresa Diago Uso; Masato Fujiki; Federico N Aucejo; Cristiano Quintini; Bijan Eghetsad; Charles M Miller; Koji Hashimoto Journal: Liver Transpl Date: 2019-03-25 Impact factor: 5.799
Authors: Emily R Perito; Douglas B Mogul; Douglas VanDerwerken; George Mazariegos; John Bucuvalas; Linda Book; Simon Horslen; Heung B Kim; Tamir Miloh; Vicky Ng; Jorge Reyes; Manuel I Rodriguez-Davalos; Pamela L Valentino; Sommer Gentry; Evelyn Hsu Journal: J Pediatr Gastroenterol Nutr Date: 2019-04 Impact factor: 2.839