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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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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. |
format | Online Article Text |
id | pubmed-10270279 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
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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