Optimal timing for living-related liver transplantation in children.
BACKGROUND
The pediatric end stage liver disease (PELD) score has been used widely to prioritize children awaiting cadaveric liver transplantation (LTx). To establish the objective parameter for optimal timing of living-related LTx (LRLTx), we have assessed our cases using the PELD score.


METHODS
From 1997 to 2002, 24 children were evaluated 28 times for the indication of LRLTx. Among them, 15 were for jaundice and nine for growth failure, hepatopulmonary syndrome, and variceal bleeding. Nine of 24 children underwent LRLTx. They were divided into several groups according to their clinical course. The PELD score consisted of age, albumin, total bilirubin, prothrombine time-international ratio (INR) and growth failure. A cut-off value was obtained by the highest positive and negative predictive value.


RESULTS
The PELD score in cases whose indication for LRLTx was approved was significantly higher compared with the cases who were not, and a cut-off value of 4 was obtained. The PELD score in cases who were alive after LRLTx was significantly lower compared with the cases who died after LRLTx or evaluation of the indication, and a cut-off value of 22 was established.


CONCLUSIONS
LRLTx may be considered when the PELD score exceeds 4, and LRLTx may be required immediately when the PELD score exceeds 22.
Kimura
Takuya
T
Department of Pediatric surgery, Osaka University Graduate School of Medicine, Osaka, Japan. kimutaku@pedsurg.med.osaka-u.ac.jp
Hasegawa
Toshimichi
T
Sasaki
Takashi
T
Shimizu
Yoshiyuki
Y
Mushiake
Sohtarou
S
Fukuzawa
Masahiro
M
Okada
Akira
A
D000293:Adolescent; D000367:Age Factors; D001656:Biliary Atresia / Q000150:complications; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000145:classification; D005183:Failure to Thrive / Q000145:classification; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000145:classification; D020065:Hepatopulmonary Syndrome / Q000145:classification; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D007565:Jaundice / Q000145:classification; D017093:Liver Failure / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors
D012709:Serum Albumin; D001663:Bilirubin