title: Developments in pediatric liver transplantation since implementation of the new allocation rules in Eurotransplant.
abstract: Liver allocation in the Eurotransplant (ET) region has changed from a waiting time to an urgency-based system using the model of end-stage liver disease (MELD) score in 2006. To allow timely transplantation, pediatric recipients are allocated by an assigned pediatric MELD independent of severity of illness. Consequences for children listed at our center were evaluated by retrospective analysis of all primary pediatric liver transplantation (LTX) from deceased donors between 2002 and 2010 (110 LTX before/50 LTX after new allocation). Of 50 children transplanted in the MELD era, 17 (34%) underwent LTX with a high-urgent status that was real in five patients (median lab MELD 22, waiting time five d) and assigned in 12 patients (lab MELD 7, waiting time 35 d). Thirty-three children received a liver by their assigned pediatric MELD (lab MELD 15, waiting time 255 d). Waiting time in the two periods was similar, whereas the wait-list mortality decreased (from about four children/yr to about one child/yr). One- and three-yr patient survival showed no significant difference (94.5/97.7%; p = 0.385) as did one- and three-yr graft survival (80.7/75.2%; and 86.5/82%; p = 0.436 before/after). Introduction of a MELD-based allocation system in ET with assignment of a granted score for pediatric recipients has led to a clear priorization of children resulting in a low wait-list mortality and good clinical outcome.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.forename: Enke
authors.initials: E
authors.lastname: Grabhorn
authors.forename: Andrea
authors.initials: A
authors.lastname: Briem-Richter
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D040841:Resource Allocation / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D014850:Waiting Lists
keywords: allocation system; liver transplantation; model of end-stage liver disease (MELD); pediatric MELD