An International Multicentre Validation Study of the Toronto Listing Criteria for Pediatric Intestinal Transplant
1Department of Paediatric Gastroenterology, Starship Child Health - Auckland District Health Board, Auckland, New Zealand, 2Division of General & Thoracic Surgery, Hospital for Sick Children, University of Toronto,, Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, ON, Canada, 3The Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom, 4Paediatric Liver, GI & Nutrition Centre, King's College Hospital, London, United Kingdom, 5The Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom, 6Children’s Hospital and Medical Centre, Omaha, NE, 7Department of Pediatrics, University of Alberta, Edmonton, AB, Canada, 8Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, ON, Canada, 9Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, 10Division of Gastroenterology, Hepatology & Nutrition, Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant Centre, Toronto, ON, Canada
Meeting: 2019 American Transplant Congress
Abstract number: 517
Keywords: Intestinal transplantation, Pediatric
Session Information
Session Name: Concurrent Session: Small Bowel
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: Room 209
*Purpose: Current intestinal transplantation (IT) listing criteria from 2001 have limited ability to predict the need for IT in the current era of intestinal failure (IF). New criteria were proposed in 2015* including >2 intensive care unit (ICU) admissions, loss of >3 central venous catheter (CVC) sites, and persistent elevation of conjugated bilirubin (CB >75mcmol/L) following 8 weeks of lipid strategies
*Methods: A retrospective, international, multicentre cohort study of 443 children from 6 centres (61 percent male, median gestational age 34 weeks [IQR 29-37]), diagnosed with IF between 2010 and 2015, was performed to validate the Toronto Listing criteria. Primary outcome measure was death/transplant. Sensitivity, specificity, negative & positive predictive value (NPV & PPV) and probability of death or transplant (OR) were calculated for each criterion
*Results: Median age at diagnosis of IF was 0.1 years (IQR 0.03-0.14) with median follow up of 3.8 years (IQR 2.3-5.3). 40/443 patients died and 53/443 were transplanted, of which 11 patients died post-transplant. Validation of the three proposed Toronto criteria demonstrated high OR, specificity and NPV and modest PPV (Table-1)
*Conclusions: This large, multicentre, international study in a contemporary cohort of IF patients, confirms the validity of the Toronto criteria across the world. These new validated criteria can therefore guide listing decisions in pediatric IT
| Toronto Listing Criteria | PPV | NPV | Sensitivity | Specificity |
| 2 or more ICU admissions | 78% | 82% | 17% | 98% |
| Loss of 3 or more CVC sites | 58% | 81% | 12% | 98% |
| Persistent CB >75mcmol/L despite 8 weeks lipid strategies | 48% | 90% | 56% | 88% |
| Toronto Listing Criteria | OR | 95% CI | p-value | |
| 2 or more ICU admissions | 10.2 | 4.0-25.6 | <0.0001 | |
| Loss of 3 or more CVC sites | 5.7 | 2.2-14.7 | 0.0003 | |
| Persistent CB >75mcmol/L despite 8 weeks lipid strategies | 8.2 | 4.8-13.9 | <0.0001 |
To cite this abstract in AMA style:
Roberts AJ, Wales PW, Beath SV, Evans HM, Hind J, Wong T, Mercer D, Yap J, Belza C, Grant D, Avitzur Y. An International Multicentre Validation Study of the Toronto Listing Criteria for Pediatric Intestinal Transplant [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/an-international-multicentre-validation-study-of-the-toronto-listing-criteria-for-pediatric-intestinal-transplant/. Accessed May 17, 2025.« Back to 2019 American Transplant Congress