https://www.ncbi.nlm.nih.gov/pubmed/32306489 Liver transplant

Am J Transplant. 2020 Apr 19. doi: 10.1111/ajt.15925. [Epub ahead of print]

Improving the Predictive Ability of the Pediatric End-Stage Liver Disease Score for Young Children Awaiting Liver Transplant.

Hsu E1, Schladt DP2, Wey A2, Perito ER3, Israni AK2,4,5.

Abstract

The current pediatric end-stage liver disease (PELD) score underestimates pediatric waitlist mortality. Childrenfrequently 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.