Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 206
Purpose: Over 30% of children listed for liver transplant (LT) have exceptions filed to increase their PELD/MELD. Non-standard exception requests (NSER) are granted by regional review boards. The impact of denial of NSER has not been studied.
Methods: UNOS data 2009-2014 on pediatric waitlist (WL) candidates, 0-18 years, analyzed excluding standard exceptions. Competing-risks regression evaluated WL death/removal for too sick, accounting for LT; backward stepwise selection with variables p<0.1 used to select multivariable (MV) models.
Results: Of 2747 WL candidates, 47%, 28%, and 25% were listed at age <2, 2-11, and 12-18 years, respectively, with 54% female, 22% Hispanic, 43% biliary atresia. Of 1216 with NSER (44%), 6.5% were never approved (n=79). WL death/removal occurred in 14% of those never approved, 5% of those approved (n=1137), and 7% with no NSER (n=1531). Denial was associated with increased risk of WL death/removal in univariate (HR=2.9, 95% CI 1.5-5.5, p=0.001) and MV (HR=2.1, 95% CI 1.0-4.2, p=0.04) analyses compared to NSER approval (Table 1). In MV model, higher MELD/PELD increased WL death/removal (HR 1.06, 95% CI 1.04-1.07, p<0.001). Gender, prior LT, region, list year did not predict WL death/removal.
|Metabolic liver disease||1.6||0.9-2.6||2.2||1.3-3.9||0.01|
|Acute liver failure||1.7||0.9-3.2||1.8||0.9-3.6||0.1|
|Exception Request||Ever approved||–||–||–||–||–|
|No exception requests||1.5||1.1-2.0||1.1||0.8-1.6||0.5|
|Listing labs, per 1 unit increase||INR||1.2||1.1-1.3|
Conclusion: Patients denied NSER are more likely to die or require removal from the WL for being too sick.
CITATION INFORMATION: Braun H, Dodge J, Rhee S, Roberts J, Perito E. Increased Waitlist Death and Removal in Pediatric Liver Transplant Recipients Denied Exception Requests. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Braun H, Dodge J, Rhee S, Roberts J, Perito E. Increased Waitlist Death and Removal in Pediatric Liver Transplant Recipients Denied Exception Requests. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/increased-waitlist-death-and-removal-in-pediatric-liver-transplant-recipients-denied-exception-requests/. Accessed September 21, 2017.
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