PELD score and posttransplant outcome in pediatric liver transplantation: a retrospective study of 100 recipients.
BACKGROUND
Pediatric End-stage Liver Disease (PELD) score is proposed as an objective tool to prioritize children awaiting liver transplantation (LT), higher PELD being associated with increased pre-LT mortality. This study investigated whether PELD may also impact on post-LT results.


METHODS
PELD was retrospectively analyzed in 100 pediatric recipients of a primary LT from living-related (n = 49) or postmortem donors (PMD, n = 51). The main pre-LT diagnosis was biliary atresia (n = 64), hepatic malignancy and fulminant hepatitis cases being excluded. PELD was calculated in all patients at the time of pre-LT assessment. Considering the median delay of 117 days between listing and LT in the PMD subgroup, a second PELD was calculated at the time of LT, allowing the determination of a delta PELD during the waiting period. PMD grafts were allocated using an allocation system taking into account waiting times as well as medical urgency, operative at EuroTransplant.


RESULTS
Overall 5-year actuarial patient and graft survivals were 96% and 91%, respectively. PELD at listing (13.3 +/- 9.7) showed a normal statistical distribution. PELD scores at listing and at LT were not found to significantly impact on post-LT outcome (NS). In contrast, higher delta PELD might be associated with lower posttransplant patient survival (p = 0.094).


CONCLUSIONS
The results of this retrospective analysis suggest that giving priority to high PELD recipients may not result in worsening post-LT outcome. Accordingly, these data support such "sickest children first" allocation policy, which should contribute to reduce pre-LT mortality without worsening post-LT results and increasing organ waste.
Bourdeaux
Christophe
C
Pediatric Liver Transplant Program, Université catholique de Louvain, Saint-Luc University Clinics, Brussels, Belgium.
Tri
Tran Thanh
TT
Gras
Jérémie
J
Sokal
Etienne
E
Otte
Jean-Bernard
JB
de Ville de Goyet
Jean
J
Reding
Raymond
R
D002648:Child; D006085:Graft Survival / Q000502:physiology*; D006130:Growth Disorders / Q000453:epidemiology; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*; D011183:Postoperative Complications / Q000453:epidemiology; D040841:Resource Allocation; D012189:Retrospective Studies; D016896:Treatment Outcome