Functional status at listing predicts waitlist and posttransplant mortality in pediatric liver transplant candidates
Year: 2018
Type: article
Study design: Observational Study
Abstract: Functional impairment is associated with mortality in adult liver transplant candidates. This has not been studied in pediatric liver transplant candidates. United Network for Organ Sharing Standard Transplant Analysis and Research files were used to investigate functional status, waitlist mortality, and posttransplant outcomes in children younger than 18 years who were waitlisted in 2006-2016 for primary liver transplant. Functional status was categorized, by using the Lansky Play-Performance Scale (LPPS), as normal/good (80-100), moderately impaired (50-70), or severely impaired (10-40) by center assessment. Among 3250 children not listed as Status 1A, 62% had an LPPS score of 80-100, 25% had a score of 50-70, and 13% had a score of 10-40 at listing. Children with an LPPS score of 10-40 at listing were more likely to die while on the waitlist (standardized hazard ratio 1.85, 95% confidence interval 1.09-3.13, P = .02) in analyses adjusting for being on a ventilator, breathing support, or dialysis and other illness severity measures. For the 2565 children transplanted, an LPPS score of 10-40 at listing drastically increased mortality risk by 1 year posttransplant (hazard ratio 5.77, 95% confidence interval 3.05-10.91, P < .0005). LPPS scores of 10-40 and 50-70 both increased the risk of graft loss by 1 year. Functional status is an independent predictor of waitlist and posttransplant mortality in pediatric liver transplant candidates. Validated tools for the assessment of functional status in these children would improve our ability to predict mortality risk-and to appropriately prioritize them for transplant.
DOI: 10.1111/ajt.15203
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
Funders: U.S. Department of Health and Human Services, National Institutes of Health, Health Resources and Services Administration, University of California, San Francisco, National Institute on Aging, National Institute of Diabetes and Digestive and Kidney Diseases, School of Medicine, University of California, San Francisco, Liver Center, University of California, San Francisco
Awards: Frailty and Functional Status in Older Liver Transplant Patients, Metabolic Syndrome after Pediatric Liver Transplant: Causes and Consequences, G1978185739, G1988855279, G208418196, G232100374, G291610258, G3182299332, G3533336020, G3613794136, G369916386, G5316135704, G8919324196, G9000059561, UCSF Liver Center, The spectrum of cognitive impairment including Alzheimer’s Disease and Related Dementias after liver transplantation
OpenAlex ID: W2902453672