//pubmed.ncbi.nlm.nih.gov/35876731/ liver transplant

Liver Transpl. 2022 Jul 25.
doi: 10.1002/lt.26548. Online ahead of print.

MELD/PELD Exception Policy and Outcomes in Pediatric Patients with Hepatopulmonary Syndrome Requiring Liver Transplantationhttps:

Muhammad H Raza # 1, Yong Kwon # 1 2 3, Pierre Kobierski 1, Asish C Misra 1 2 3, Angelina Lim 1, Cameron Goldbeck 2, Kambiz Etesami 1 2 3, Rohit Kohli 1 3 4, Juliet Emamaullee 1 2 3

PMID: 35876731

DOI: 10.1002/lt.26548
Abstract

Background: Hepatopulmonary syndrome (HPS) is associated with increased waitlist mortality in liver transplant (LT) candidates. Children with HPS are granted MELD/PELD exception points for waitlist prioritization in the U.S. based on criterion developed for adults. In this study, the impact of this MELD/PELD exception policy on post-LT survival in children was examined.

Methods: A retrospective cohort of patients <18 years with a MELD/PELD exception request who underwent LT between 2007-2018 were identified in the SRTR. Patients were stratified by waitlist PaO2 to assess risk factors for waitlist mortality and post-LT survival.

Results: Among 3,082 pediatric LT recipients included in the study, 124 patients (4%) received MELD/PELD exception points for HPS. Patients with HPS were median 9 [6, 12] years old, 54.8% female, and 54% white. Most patients (87.9%) were listed with a lab MELD/PELD <15. Waitlist mortality for patients with HPS exception points was rare and not different from non-HPS patients. When stratified by pre-LT PaO2 , hypoxemia severity was not associated with differences in 1, 3, or 5-year survival post-LT (p=0.13). However, HPS patients showed a slightly lower survival at 5-years compared to non-HPS patients (88.7% vs 93.4%; p=0.04).

Conclusions: MELD/PELD exception for children with HPS mitigated waitlist mortality, and recipients with HPS experience excellent 5-year survival post-LT, though slightly lower than in patients without HPS. Unlike adults with HPS, severity of pre-LT hypoxemia in children does not impact post-LT survival. These data suggest that adult criteria for granting MELD/PELD exception points may not appropriately capture HPS severity in pediatric patients. Further prospective multicenter studies to examine risk factors predicting negative survival outcomes in children with HPS are warranted.

Published on: 
Jul-2022

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