Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Department of Pediatrics, Johns Hopkins University, Baltimore.
J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):472-479. doi: 10.1097/MPG.0000000000002287.
The aim of the study was to investigate the impact of prioritizing infants, children, adolescents, and the sickest adults (Status 1) for deceased donor livers. We compared outcomes under two "SharePeds" allocation schema, which prioritize children and Status 1 adults for national sharing and enhanced access to pediatric donors or all donors younger than 35 years, to outcomes under the allocation plan approved by the Organ Procurement and Transplant Network in December 2017 (Organ Procurement and Transplantation Network [OPTN] 12-2017).
The 2017 Liver Simulated Allocation Model and Scientific Registry of Transplant Recipients data on all US liver transplant candidates and liver offers 7/2013 to 6/2016 were used to predict waitlist deaths, transplants, and post-transplant deaths under the OPTN 12-2017 and SharePeds schema.
Prioritizing national sharing of pediatric donor livers with children (SharePeds 1) would decrease waitlist deaths for infants (<2 years, P = 0.0003) and children (2-11 years, P = 0.001), with no significant change for adults (P = 0.13). Prioritizing national sharing of all younger than 35-year-old deceased donor livers with children and Status 1A adults (SharePeds 2) would decrease waitlist deaths for infants, children, and all Status 1A/B patients (P < 0.0001 for each). SharePeds 1 and 2 would increase the number of liver transplants done in infants, children, and adolescents compared to the OPTN-2017 schema (P < 0.00005 for all age groups). Both SharePeds schema would increase the percentage of pediatric livers transplanted into pediatric recipients.
Waitlist deaths could be significantly decreased, and liver transplants increased, for children and the sickest adults, by prioritizing children for pediatric livers and with broader national sharing of deceased donor livers.
本研究旨在探讨优先考虑婴儿、儿童、青少年和病最严重的成年人（状态 1）接受已故供体肝脏的影响。我们比较了两种“SharePeds”分配方案下的结果，这两种方案优先考虑儿童和状态 1 成人进行国家共享，并增加了对儿科供体或所有 35 岁以下供体的获取途径，与 2017 年 12 月器官获取与移植网络批准的分配计划（器官获取与移植网络 [OPTN] 12-2017）的结果进行比较。
使用 2017 年肝脏模拟分配模型和移植受者科学登记处的数据，对所有美国肝移植候选人和肝供体进行了研究，这些数据来自 2013 年 7 月至 2016 年 6 月，用于预测 OPTN 12-2017 和 SharePeds 方案下的等待名单死亡、移植和移植后死亡。
优先考虑国家共享儿科供体肝脏给儿童（SharePeds 1）将降低婴儿（<2 岁，P=0.0003）和儿童（2-11 岁，P=0.001）的等待名单死亡人数，而成年人则没有显著变化（P=0.13）。优先考虑国家共享所有 35 岁以下已故供体肝脏给儿童和状态 1A 成年人（SharePeds 2）将降低婴儿、儿童和所有状态 1A/B 患者的等待名单死亡人数（P<0.0001 ）。与 OPTN-2017 方案相比，SharePeds 1 和 2 将增加婴儿、儿童和青少年的肝移植数量（所有年龄组 P<0.00005）。两种 SharePeds 方案都将增加将儿科供体肝脏移植给儿科受者的比例。
通过优先考虑儿童获得儿科肝脏，并更广泛地进行全国性的已故供体肝脏共享，可以显著降低儿童和病最严重的成年人的等待名单死亡人数，并增加肝移植数量。
