![]() ![]() The Pediatric End-stage Liver Disease (PELD) score has been used to allocate livers for transplant in children since February 27, 2002, when the Organ Procurement and Transplantation Network (OPTN) adopted a prioritization algorithm based on risk of 90-day pretransplant death (ie, death without receiving a transplant). Children with chronic liver disease who are in need of transplant may be at a disadvantage compared with adults in a similar situation. However, the estimated 90-day mortality using the PELD score underestimated the actual probability of death by as much as 17%.Ĭonclusions and Relevance With use of the PELD score, the ranking of risk among children was preserved, but direct comparisons between adult and pediatric candidates were not accurate. Results Among the 4298 patients in the full cohort (mean age, 2.5 years 2251 female 2201 white), PELD scores and mortality were concordant (C statistic, 0.8387 for the full cohort and 0.8123 for the reduced cohort). Main Outcomes and Measures Observed and expected 90-day pretransplant mortality rates evaluated at 10-point interval PELD levels. The reduced cohort (n = 2421) excluded patients receiving living donor transplantation or PELD exception points. The full cohort comprised 4298 patients (<18 years of age) who had chronic liver disease (excluding cancer). The study analyzed 2 cohorts using the UNOS Standard Transplant Analysis and Research data files. Objective To evaluate the accuracy of the PELD score in estimating 90-day pretransplant mortality among pediatric patients on the United Network for Organ Sharing (UNOS) waiting list.ĭesign, Setting, and Participants Patients who were listed from February 27, 2002, to March 31, 2014, for primary liver transplant were included in this retrospective analysis and were followed up for at least 2 years through June 17, 2016. Widespread reliance on exceptions for pediatric recipients suggests that the 2 systems may not be comparable. Importance Fair allocation of livers between pediatric and adult recipients is critically dependent on the accuracy of mortality estimates afforded by the Pediatric End-stage Liver Disease (PELD) and Model for End-stage Liver Disease, respectively. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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