title: Pediatric intestinal transplant listing criteria - a call for a change in the new era of intestinal failure outcomes.
abstract: Current listing indications used for intestinal transplantation (IT) were proposed in 2001. We undertook the present single center study to see if these criteria are still valid. The 2001 criteria (advanced cholestasis, loss of >50% central venous catheter (CVC) sites, ≥2 sepsis/year, ultrashort bowel) were compared in children with intestinal failure in old era-1998-2005 (N = 99) to current era-2006-2012 (N = 91) to predict the need for IT using sensitivity, specificity, NPV and PPV. Two 2001 criteria had poorer predictive value in the current era: Advanced cholestasis (PPV 64% old vs. 40% current era; sensitivity 84% vs. 65%, respectively) and ultrashort bowel (PPV 100% old vs. 9% current era; sensitivity 10% vs. 4%, respectively). Three newly proposed criteria had high predictive value: ≥2 ICU admissions (p = 0.0001, OR 23.6, 95% CI 2.7-209.8), persistent bilirubin >75 mmol/L despite lipid strategies (p = 0.0005, OR 24.0, 95% CI 3.2-177.4), and loss of ≥3 CVC sites (p = 0.0003, OR 33.3, 95% CI 18.8-54.0). There was 98% probability of needing IT when two of these new criteria were present. The 2001 IT criteria have limited predictive ability in the current era and should be revised. A multicenter study is required to validate the findings of this single center experience.
authors: Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, Ontario, Canada.|Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: K M
authors: KM
authors: Burghardt
authors: Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, Ontario, Canada.|Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: P W
authors: PW
authors: Wales
authors: Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, Ontario, Canada.
authors: N
authors: N
authors: de Silva
authors: Biostatistics Department, University Health Network and Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
authors: D
authors: D
authors: Stephens
authors: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors: J
authors: J
authors: Yap
authors: Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: D
authors: D
authors: Grant
authors: Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, Ontario, Canada.|Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors: Y
authors: Y
authors: Avitzur
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D008297:Male; D016377:Organ Transplantation / Q000639:trends*; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Clinical decision-making; intestinal failure/injury; recipient selection