Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Purpose: Over 50% of pediatric liver transplant (LT) candidates receive exceptions to increase PELD/MELD; more than [frac12] are non-standard exception requests (NSER) based on narrative justifications. This is the first study of UNOS NSER narratives in pediatric LT.
Methods: UNOS STAR and NSER narrative data 2009-2014 for pediatric LT candidates, 0-18 at listing, was coded by 2 authors and analyzed with content analysis, chi-square tests, logistic regression.
Results: 1381 NSER narratives on 1216 waitlist candidates (1137 approvals, 244 denials). 76% approved on first NSER, 7% on later NSER, 7% never approved. Biliary atresia associated with approval, older age with denial.(Table 1) Common justifications associated with approval: disease trajectory, risk of death, failure to thrive, biliary complications, pruritus. Justifications associated with denial: encephalopathy, impaired quality of life, SE outside criteria.
|% of NSER (n=1381)||Odds of NSER Denial|
|Associated with approval|
Biliary atresia (vs. any other diagnosis)
|Any complication of liver disease||84||0.5||0.4-0.7||<0.001|
|Risk of waitlist death||38||0.7||0.5-0.9||0.008|
|Failure to thrive (FTT)||45||0.5||0.3-0.6||<0.001|
|-Failure to thrive despite NG/GT, TPN||27||0.4||0.3-0.6||<0.001|
|Associated with denial|
|2-11 years at listing (vs. ≤2)||28||1.6||1.1-2.4||0.01|
|≥12 years at listing (vs. ≤2)||25||5.5||3.9-7.7||<0.001|
|Impaired quality of life||10||1.7||1.1-2.6||0.01|
|Standard exception, outside criteria||7||1.9||1.2-3.1||0.01|
|≥10% of NSER, not associated with approval/denial|
|Ascites, other edema||36||0.9||0.7-1.3||0.7|
|Repeat/extended hospital admission||25||0.9||0.6-1.1||0.3|
|Bleeding from varices||19||1.1||0.8-1.6||0.5|
Conclusion: There are common justifications in NSER. These narratives are a key resource to inform revisions of the PELD/MELD system.
CITATION INFORMATION: Braun H, Rhee S, Dodge J, Roberts J, Perito E. Pediatric Liver Transplant Exception Request Narratives – How Do We Justify Requests? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Braun H, Rhee S, Dodge J, Roberts J, Perito E. Pediatric Liver Transplant Exception Request Narratives – How Do We Justify Requests? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/pediatric-liver-transplant-exception-request-narratives-how-do-we-justify-requests/. Accessed March 6, 2021.
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