Unknown

Dataset Information

0

Impact of the Pediatric End-Stage Liver Disease (PELD) growth failure thresholds on mortality among pediatric liver transplant candidates.


ABSTRACT: The Pediatric End-Stage Liver Disease (PELD) score is intended to determine priority for children awaiting liver transplantation. This study examines the impact of PELD's incorporation of "growth failure" as a threshold variable, defined as having weight or height <2 standard deviations below the age and gender norm (z-score <2). First, we demonstrate the "growth failure gap" created by PELD's current calculation methods, in which children have z-scores <2 but do not meet PELD's growth failure criteria and thus lose 6-7 PELD points. Second, we utilized United Network for Organ Sharing (UNOS) data to investigate the impact of this "growth failure gap." Among 3291 pediatric liver transplant candidates, 26% met PELD-defined growth failure, and 17% fell in the growth failure gap. Children in the growth failure gap had a higher risk of waitlist mortality than those without growth failure (adjusted subhazard ratio [SHR] 1.78, 95% confidence interval [95% CI] 1.05-3.02, P = .03). They also had a higher risk of posttransplant mortality (adjusted HR 1.55, 95% CI 1.03-2.32, P = .03). For children without PELD exception points (n = 1291), waitlist mortality risk nearly tripled for those in the gap (SHR 2.89, 95% CI 1.39-6.01, P = .005). Current methods for determining growth failure in PELD disadvantage candidates arbitrarily and increase their waitlist mortality risk. PELD should be revised to correct this disparity.

SUBMITTER: Swenson SM 

PROVIDER: S-EPMC6883133 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

altmetric image

Publications

Impact of the Pediatric End-Stage Liver Disease (PELD) growth failure thresholds on mortality among pediatric liver transplant candidates.

Swenson Sonja M SM   Roberts John P JP   Rhee Sue S   Perito Emily R ER  

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20190903 12


The Pediatric End-Stage Liver Disease (PELD) score is intended to determine priority for children awaiting liver transplantation. This study examines the impact of PELD's incorporation of "growth failure" as a threshold variable, defined as having weight or height <2 standard deviations below the age and gender norm (z-score <2). First, we demonstrate the "growth failure gap" created by PELD's current calculation methods, in which children have z-scores <2 but do not meet PELD's growth failure c  ...[more]

Similar Datasets

| S-EPMC6248160 | biostudies-literature
| S-EPMC6482090 | biostudies-literature
| S-EPMC5083236 | biostudies-literature
| S-EPMC7063516 | biostudies-literature
| S-EPMC7319877 | biostudies-literature
| S-EPMC8597089 | biostudies-literature
| S-EPMC6275095 | biostudies-literature
| S-EPMC3319293 | biostudies-literature
| S-EPMC7293821 | biostudies-literature
| S-EPMC8248423 | biostudies-literature