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Improving the predictive ability of the pediatric end‐stage liver disease score for young children awaiting liver transplant
Author(s) -
Hsu Evelyn,
Schladt David P.,
Wey Andrew,
Perito Emily R.,
Israni Ajay K.
Publication year - 2021
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.15925
Subject(s) - medicine , liver disease , pediatrics , liver transplantation , mortality rate , model for end stage liver disease , creatinine , pediatric gastroenterology , transplantation , disease
The current pediatric end‐stage liver disease (PELD) score underestimates pediatric waitlist mortality. Children frequently require PELD exception points to achieve appropriate priority ranking. We developed a new PELD score using serum sodium, creatinine, and updated original PELD components to more accurately rank children and equalize children's mortality risk with the age‐standardized mortality rate of adults. We included children aged younger than 12 years with chronic liver disease, listed for deceased donor livers January 1, 2005‐December 31, 2017. Pediatric candidates (n = 5111) were followed from listing to the earliest of waitlist mortality (death or removal from the list due to being too sick to undergo transplant, n = 339) or 180 days. We incorporated linear splines for the current components of PELD and added sodium and creatinine to the equation. The updated PELD‐Na‐Cr had a cross‐validated AUC ROC of 0.854, vs 0.799 for the original PELD. PELD‐Na‐Cr required 9.44 additional points to equalize children's mortality risk with the age‐standardized mortality rate of adults. PELD‐Na‐Cr better ordered the sickest children and should better prioritize children relative to adults. As a result, PELD‐Na‐Cr could increase pediatric transplant rates and reduce pediatric liver transplant waitlist mortality.