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Impact of the Pediatric End‐Stage Liver Disease ( PELD ) growth failure thresholds on mortality among pediatric liver transplant candidates
Author(s) -
Swenson Sonja M.,
Roberts John P.,
Rhee Sue,
Perito Emily R.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15552
Subject(s) - medicine , liver transplantation , liver disease , confidence interval , pediatrics , transplantation
The Pediatric End‐Stage Liver Disease ( PELD ) score is intended to determine priority for children awaiting liver transplantation. This study examines the impact of PELD 's incorporation of “growth failure” as a threshold variable, defined as having weight or height <2 standard deviations below the age and gender norm ( z ‐score <2). First, we demonstrate the “growth failure gap” created by PELD 's current calculation methods, in which children have z ‐scores <2 but do not meet PELD 's growth failure criteria and thus lose 6‐7 PELD points. Second, we utilized United Network for Organ Sharing ( UNOS ) data to investigate the impact of this “growth failure gap.” Among 3291 pediatric liver transplant candidates, 26% met PELD ‐defined growth failure, and 17% fell in the growth failure gap. Children in the growth failure gap had a higher risk of waitlist mortality than those without growth failure (adjusted subhazard ratio [ SHR ] 1.78, 95% confidence interval [95% CI] 1.05‐3.02, P = .03). They also had a higher risk of posttransplant mortality (adjusted HR 1.55, 95% CI 1.03‐2.32, P = .03). For children without PELD exception points (n = 1291), waitlist mortality risk nearly tripled for those in the gap ( SHR 2.89, 95% CI 1.39‐6.01, P = .005). Current methods for determining growth failure in PELD disadvantage candidates arbitrarily and increase their waitlist mortality risk. PELD should be revised to correct this disparity.