Allocation for deceased donor livers is prioritized in the U.S. by waitlist mortality, as predicted by PELD for children<12 years, and MELD for individuals>12 years. Adult candidates that experience a sudden increase (“spike”) in MELD have substantially higher waitlist mortality, suggesting that they might require different allocation priority. However, pediatric patients have potentially different disease trajectories, and it remains unknown if such a spike affects waitlist mortality for pediatric candidates in a similar manner.

Methods: Pediatric (age<18) patients waitlisted between 2002-2015 were studied using SRTR data. Individuals were excluded if they received a multi-organ transplant, re-transplant, exception points, or status 1a/b priority. A spike was defined as greater than 80% increase in PELD/MELD over the lowest value in preceding 7 days. Multivariate logistic regression was performed to predict the odds of 7-day waitlist mortality for individuals with a spike compared to those individuals without a spike, after adjusting for PELD/MELD; the association between a spike and 7-day mortality was also assessed at different PELD/MELD scores.

Results: Of 2,129 eligible registrants, 252 experienced a PELD/MELD spike. A spike was associated with 41% increase in 7-day waitlist mortality (OR=_1.011.41_1.98, p=0.041) after adjusting for current PELD/MELD. However, the association between spike and 7-day mortality varid by PELD/MELD (interaction: p<0.001), conferring a higher risk of mortality for registrants with PELD/MELD below 30, but actually a lower risk of mortality for registrants with PELD/MELD of 40 (Table 1):

Conclusions: Waitlisted children with a spike in PELD/MELD demonstrated varied changes in risk of 7-day waitlist mortality, with individuals at lower PELD/MELD demonstrating increased likelihood of death. Future policy may benefit from incorporation of these spikes into a candidate's score in order to more accurately allocate organs based on waitlist mortality.

CITATION INFORMATION: Luo X, Mogul D, Massie A, Segev D. Sudden Increase in Allocation Score for Pediatric Liver Transplant Candidates Predicts Waitlist Mortality. Am J Transplant. 2016;16 (suppl 3).

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