Improving the predictive ability of the pediatric end-stage liver disease score for young children awaiting liver transplant.
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
27
09
2019
revised:
05
03
2020
accepted:
05
04
2020
pubmed:
20
4
2020
medline:
22
6
2021
entrez:
20
4
2020
Statut:
ppublish
Résumé
The current pediatric end-stage liver disease (PELD) score underestimates pediatric waitlist mortality. Children frequently require PELD exception points to achieve appropriate priority ranking. We developed a new PELD score using serum sodium, creatinine, and updated original PELD components to more accurately rank children and equalize children's mortality risk with the age-standardized mortality rate of adults. We included children aged younger than 12 years with chronic liver disease, listed for deceased donor livers January 1, 2005-December 31, 2017. Pediatric candidates (n = 5111) were followed from listing to the earliest of waitlist mortality (death or removal from the list due to being too sick to undergo transplant, n = 339) or 180 days. We incorporated linear splines for the current components of PELD and added sodium and creatinine to the equation. The updated PELD-Na-Cr had a cross-validated AUC ROC of 0.854, vs 0.799 for the original PELD. PELD-Na-Cr required 9.44 additional points to equalize children's mortality risk with the age-standardized mortality rate of adults. PELD-Na-Cr better ordered the sickest children and should better prioritize children relative to adults. As a result, PELD-Na-Cr could increase pediatric transplant rates and reduce pediatric liver transplant waitlist mortality.
Identifiants
pubmed: 32306489
doi: 10.1111/ajt.15925
pii: S1600-6135(22)08331-9
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
222-228Subventions
Organisme : HRSA HHS
ID : HHSH250201000018C
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
Références
Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
Elwir S, Lake J. Current status of liver allocation in the United States. Gastroenterol Hepatol (NY). 2016;12(3):166-170.
McDiarmid SV, Anand R, Lindblad AS. Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group. Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation. 2002;74(2):173-181.
Mazariegos G, Anand R, Mcdiarmid S, et al. Validation of PELD severity score in a pediatric transplant candidate database. Am J Transplant. 2002;2(S3):249-276 [abstract 451].
Chang C-C, Bryce CL, Shneider BL, et al. Accuracy of the pediatric end-stage liver disease score in estimating pretransplant mortality among pediatric liver transplant candidates. JAMA Pediatr. 2018;172(11):1070-1077.
Swenson SM, Roberts JP, Rhee S, Perito ER. Impact of the pediatric end-stage liver disease (PELD) growth failure thresholds on mortality among pediatric liver transplant candidates. Am J Transplant. 2019;19(12):3308-3318. [Epub ahead of print].
Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130(6):1652-1660.
Biggins SW, Rodriguez HJ, Bacchetti P, Bass NM, Roberts JP, Terrault NA. Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology. 2005;41(1):32-39.
Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002;May(246): 1-190.
Centers for Disease Control and Prevention. A SAS Program for the 2000 CDC Growth Charts (ages 0-20 years). https://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm. Accessed March 4, 2020.
Marshall A, Altman DG, Holder RL, Royston P. Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines. BMC Med Res Methodol. 2009;9:57.
Kalbfleisch JD, Prentice RL. The statistical analysis of failure time date. Hoboken NJ: John Wiley and Sons; 2002.
Hsu EK, Mazariegos GV. Global lessons in graft type and pediatric liver allocation: A path toward improving outcomes and eliminating wait-list mortality. Liver Transpl. 2017;23(1):86-95.