Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Access to pediatric liver transplant expertise varies nationally and variability in practice leads to potential suboptimal organ utilization and outcomes. A multi-institutional collaborative was developed and deployed over all facets of pre, peri and post -transplant phases.
*Methods: Initial planning consisted of site visits, nursing and physician exchange, protocol development and contracting occurred in stages between 2013-2016 with clinical operations beginning in May 2016. Program clinical support was individualized based on initial visits, but consists of nursing, anesthesia and critical care along with donor and recipient surgical support. On site and telemedicine approaches were employed for ongoing consultation. Quality metrics were followed in individual institutional meetings and were shared across centers.
*Results: Utilizing standardized immunosuppressive and peri-operative protocols, ninety isolated pediatric liver and 5 simultaneous liver-kidney transplants were performed at 3 institutions from May 2016 and October 2018. Current patient and graft survival is 96.4%. Mean age and weight at transplant was 8.6 +/- 8.3 years and 28.04+/-22.8kg respectively and LOS was 22+/-15.9 days across the centers with 448 +/- 278 days of follow-up. Pediatric wait list mortality was zero.
|Institution||UPMC Children’s Hospital of Pittsburgh (5-2016 to 10-2018)||University of Virginia (5-2016 to 10-2018)||Florida Hospital for Children (5-2018 to 10-2018)|
|Total Case volume||74||17||4|
|Wait list mortality||0||0||0|
|Graft type (Whole /split /reduced/living donor /domino)||30/12/1/23/8||6/11/0/0||3/1/0/0|
|Split lobe shared with second recipient||11 (85%) eligible grafts||10 (90%) of eligible grafts||1 (100% of eligible grafts)|
*Conclusions: A new paradigm for pediatric transplant surgical and medical care is described with excellent short-term outcomes. Variation in pediatric patient and liver graft survival differs significantly across the country. There is similar variation in the utilization of technical variant allografts for children on the waiting. A high degree of split and domino liver allograft utilization was demonstrated in this series when the primary recipient was a child. This coordinated approach resulted in optimal organ utilization between the collaborative institutions. In addition, standardization of surgical and medical approaches may eliminate wait list mortality, increase technical variant usage, and normalize outcomes across a multi-institutional network.
To cite this abstract in AMA style:Soltys K, Rassmussen SK, Squires J, Sindhi R, Pelletier S, Brayman K, Angelis M, Chin T, Teaster R, Oberholzer J, Gonzalez-Peralta R, Friedman B, Hupp D, Mendoza M, Eicker PA, Middleton J, Mazariegos G. Development and Implementation of a Pediatric Transplant Consortium [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/development-and-implementation-of-a-pediatric-transplant-consortium/. Accessed December 8, 2019.
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