Waitlist Outcomes After Acuity Circle-Based Distribution in Pediatric Liver Transplantation Restricted; Files Only

Abstract

Pediatric liver transplant (LT) waitlist mortality has been stagnant for several years. In 2020, the Organ Procurement and Transplantation Network (OPTN) implemented acuity circles (AC)-based liver distribution and national pediatric prioritization of pediatric donor livers. Using OPTN data, waitlist outcomes for pediatric LT candidates listed between February 4, 2016 and February 3, 2024, were studied by age group and era relative to AC implementation. There were 5,605 pediatric waitlist registrations and 3,778 pediatric liver transplants during the study period. At 1 year, cumulative incidence of transplant was 77.8% pre-AC vs 79.9% post-AC, while cumulative incidence of mortality was 5.4% pre-AC vs 5.9% post-AC. Median allocation MELD/PELD at LT significantly decreased across all age groups post-AC (p<0.001). For candidates age 12-17 years, cumulative incidence of transplant increased (65.6% pre-AC to 79.5% post-AC at 1 year), median time to transplant decreased (66 days pre-AC to 37 days post-AC, p<0.001), and proportion of recipients receiving pediatric donor livers increased (37.9% pre-AC vs 66.2% post-AC, p<0.001). AC group was associated with increased likelihood of waitlist mortality for those age 1-5 years and increased likelihood of transplant for those age 12-17 years. LT candidates age 12-17 years derived the most benefit from AC-based liver distribution.

Table of Contents

Table of Contents

Chapter 1: Background Literature Review                                                                          1

Student Contribution                                                                                                           10       

Chapter 2: Journal Article                                                                                                   11

Abstract                                                                                                                                   13

Introduction                                                                                                                           14

Methods                                                                                                                                  15       

Results                                                                                                                                    17

Discussion                                                                                                                              20       

Tables and Figures                                                                                                                24

Chapter 3: Future Directions/Public Health Implications                                            35

References                                                                                                                              38

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	acuity circles pediatric waitlist outcomes liver transplantation
Committee Chair / Thesis Advisor	Ross-Driscoll, Katherine, Emory University
Committee Members	Magliocca, Joseph, Vanderbilt University

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