Regional variation and use of exception letters for cadaveric liver allocation in children with chronic liver disease.
The Pediatric End-Stage Liver Disease (PELD) score was designed to reduce subjectivity in liver allocation and to advantage patients with a higher probability of waiting list mortality. The aims of this study were to determine the impact of PELD implementation for children with chronic liver disease and to assess whether PELD met its goal of standardization of liver allocation for children. This study used data reported to the United Network for Organ Sharing (UNOS) registry for children with chronic liver disease receiving primary cadaveric liver transplant between January 2000 and December 2001 (pre-PELD) and March 2002 and July 2003 (PELD). PELD reduced the percentage of children transplanted while in an intensive care unit and as status 1. A calculated PELD score was used for allocation in only 52% of recipients. Thirty percent were status 1 at transplant and PELD scores granted by exception were used for allocation in 18% of patients. There was regional variation in PELD score at allocation and use of exception scores with a significant relationship between PELD score and percentage of exception cases. Regional variation suggests that PELD has not resulted in standardization of listing practices in pediatric liver transplantation.
Department of Surgery, The Siragusa Transplantation Center, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago 60614, IL, USA.
Paolo R
PR
Salvalaggio
Katie
K
Neighbors
Susan
S
Kelly
Karan M
KM
Emerick
Kishore
K
Iyer
Riccardo A
RA
Superina
Peter F
PF
Whitington
Estella M
EM
Alonso
D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015709:Correspondence as Topic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D040841:Resource Allocation / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome; D014850:Waiting Lists