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Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States

To assess the impact of technical variant grafts (TVGs) [including living donor (LD) and deceased donor split/partial grafts] on waitlist (WL) and transplant outcomes for pediatric liver transplant (LT) candidates, we performed a retrospective analysis of Organ Procurement and Transplantation Networ...

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Autores principales: Mazariegos, George V., Perito, Emily R., Squires, James E., Soltys, Kyle A., Griesemer, Adam D., Taylor, Sarah A., Pahl, Eric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10270279/
https://www.ncbi.nlm.nih.gov/pubmed/36746117
http://dx.doi.org/10.1097/LVT.0000000000000091
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author Mazariegos, George V.
Perito, Emily R.
Squires, James E.
Soltys, Kyle A.
Griesemer, Adam D.
Taylor, Sarah A.
Pahl, Eric
author_facet Mazariegos, George V.
Perito, Emily R.
Squires, James E.
Soltys, Kyle A.
Griesemer, Adam D.
Taylor, Sarah A.
Pahl, Eric
author_sort Mazariegos, George V.
collection PubMed
description To assess the impact of technical variant grafts (TVGs) [including living donor (LD) and deceased donor split/partial grafts] on waitlist (WL) and transplant outcomes for pediatric liver transplant (LT) candidates, we performed a retrospective analysis of Organ Procurement and Transplantation Network (OPTN) data on first-time LT or liver-kidney pediatric candidates listed at centers that performed >10 LTs during the study period, 2004–2020. Center variance was plotted for LT volume, TVG usage, and survival. A composite center metric of TVG usage and WL mortality was developed to demonstrate the existing variation and potential for improvement. Sixty-four centers performed 7842 LTs; 657 children died on the WL. Proportions of WL mortality by center ranged from 0% to 31% and those of TVG usage from 0% to 76%. Higher TVG usage, from deceased donor or LD, independently or in combination, significantly correlated with lower WL mortality. In multivariable analyses, death from listing was significantly lower with increased center TVG usage (HR = 0.611, CI: 0.40–0.92) and LT volume (HR = 0.995, CI: 0.99–1.0). Recipients of LD transplants (HR = 0.637, CI: 0.51–0.79) had significantly increased survival from transplant compared with other graft types, and recipients of deceased donor TVGs (HR = 1.066, CI: 0.93–1.22) had statistically similar outcomes compared with whole graft recipients. Increased TVG utilization may decrease WL mortality in the US. Hence, policy and training to increase TVG usage, availability, and expertise are critical.
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spelling pubmed-102702792023-06-16 Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States Mazariegos, George V. Perito, Emily R. Squires, James E. Soltys, Kyle A. Griesemer, Adam D. Taylor, Sarah A. Pahl, Eric Liver Transpl Original Articles: Waitlist Outcomes and Organ Allocation To assess the impact of technical variant grafts (TVGs) [including living donor (LD) and deceased donor split/partial grafts] on waitlist (WL) and transplant outcomes for pediatric liver transplant (LT) candidates, we performed a retrospective analysis of Organ Procurement and Transplantation Network (OPTN) data on first-time LT or liver-kidney pediatric candidates listed at centers that performed >10 LTs during the study period, 2004–2020. Center variance was plotted for LT volume, TVG usage, and survival. A composite center metric of TVG usage and WL mortality was developed to demonstrate the existing variation and potential for improvement. Sixty-four centers performed 7842 LTs; 657 children died on the WL. Proportions of WL mortality by center ranged from 0% to 31% and those of TVG usage from 0% to 76%. Higher TVG usage, from deceased donor or LD, independently or in combination, significantly correlated with lower WL mortality. In multivariable analyses, death from listing was significantly lower with increased center TVG usage (HR = 0.611, CI: 0.40–0.92) and LT volume (HR = 0.995, CI: 0.99–1.0). Recipients of LD transplants (HR = 0.637, CI: 0.51–0.79) had significantly increased survival from transplant compared with other graft types, and recipients of deceased donor TVGs (HR = 1.066, CI: 0.93–1.22) had statistically similar outcomes compared with whole graft recipients. Increased TVG utilization may decrease WL mortality in the US. Hence, policy and training to increase TVG usage, availability, and expertise are critical. Lippincott Williams & Wilkins 2023-07 2023-02-07 /pmc/articles/PMC10270279/ /pubmed/36746117 http://dx.doi.org/10.1097/LVT.0000000000000091 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Articles: Waitlist Outcomes and Organ Allocation
Mazariegos, George V.
Perito, Emily R.
Squires, James E.
Soltys, Kyle A.
Griesemer, Adam D.
Taylor, Sarah A.
Pahl, Eric
Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States
title Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States
title_full Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States
title_fullStr Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States
title_full_unstemmed Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States
title_short Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States
title_sort center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the united states
topic Original Articles: Waitlist Outcomes and Organ Allocation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10270279/
https://www.ncbi.nlm.nih.gov/pubmed/36746117
http://dx.doi.org/10.1097/LVT.0000000000000091
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