C.S. Brown1, J. Torabi3, L. Van Leeuwen2, J. Dinorcia2, J. Chu3, Z. Akhtar2 1Icahn School of Medicine at Mount Sinai, New York, NY, USA 2Recanti/Miller Transplantation Institute, Mount Sinai, New York, NEW YORK, USA 3Mount Sinai Hospital, New York, NEW YORK, USA
Introduction:
Outcomes after pediatric liver transplantation are excellent, but waiting list mortality remains stagnant due to a shortage of suitable, size-matched allografts. Livers from extended criteria donors (ECD) such as donation after cardiac death (DCD) donors are used infrequently in pediatric liver transplant and represent an untapped source of potential liver allografts. Machine perfusion is changing the landscape of liver transplant using ECD liver allografts in adults and is poised for use in children. Pediatric candidates with prolonged wait times and high waiting list mortality may be suitable for ECD liver allografts optimized by machine perfusion technology. This study aims to identify the pediatric candidates awaiting liver transplant who might benefit from using machine perfusion to transplant ECD livers.
Methods:
We used the OPTN UNOS database to identify patients aged 0-18 years listed for liver transplant between 2010 and 2021. Age, demographics, liver disease, MELD/PELD scores, cause of death, and region were analyzed with relation to wait time and waiting list mortality.
Results:
A total of 9092 pediatric candidates were listed for liver transplant with a median age of 5.5 years. Children less than one year of age made up a significant proportion of the waitlist (44.0%) and had a mortality rate of 12.4%. Older pediatric candidates constituted smaller proportions of the waiting list but had similar mortality rates, with candidates aged 2-10 years (29.6% of the waitlist) having 11.8% and candidates aged 11-17 years (26.4% of the waitlist) having 12.6% risk of death, respectively. Older candidates spent significantly more time on the waiting list in both transplanted and non-transplanted cases (Table 1). Compared to candidates in the first year of life, candidates from ages 2-10 years and 11-18 years spent nearly 100 more days on the waiting list on average before being removed from the waitlist for being too ill for transplant or death.
Conclusion:
Adolescent pediatric liver transplant candidates spend more time on the waiting list and have similar risk of death compared to younger candidates, making them an ideal group for interventions to increase access to transplant. Machine perfusion is expanding the use of ECD liver allografts such as DCD livers in adults. Given the size similarity to adults, adolescent candidates awaiting liver transplant may be the next group to benefit from the use of machine perfusion to expand the donor pool and decrease waiting list mortality.