Liver transplant: PELD score underestimates waitlist mortality in children

  • Chang CH & al.
  • JAMA Pediatr
  • 17 Sep 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • The Pediatric End-stage Liver Disease (PELD) score underestimates the actual probability of 90-day waitlist mortality in children needing primary liver transplant.

Why this matters

  • PELD score accurately ranked risk for children, but direct comparisons with the adult Model for End-stage Liver Disease (MELD) score were not accurate.
  • “Children with chronic liver disease who are in need of transplant may be at a disadvantage compared with adults in a similar situation," the authors write.

Study design

  • Retrospective study of 4298 pediatric patients (mean age, 2.5±4.2 years) on the United Network for Organ Sharing (UNOS) waiting list for primary liver transplant during 2002-2014.
  • A reduced cohort excluded patients receiving liver donor transplant (n=464) or PELD exception points (n=1413).
  • Follow-up: ≥2 years, until 2016.
  • Funding: National Institute of Diabetes and Digestive and Kidney Diseases; NIH; Health Resources and Services Administration.

Key results

  • PELD scores were concordant with 90-day waitlist mortality in the full cohort (concordance [C]-statistic, 0.8387; 95% CI, 0.8191-0.8584) and reduced cohort (C-statistic, 0.8123; 95% CI, 0.7919-0.8327), suggesting good discrimination.
  • However, calibration was low: expected 90-day waitlist mortality rates were underestimated vs observed rates, and the difference rose with PELD score.
  • PELD score underestimated the actual probability of death by up to 17%.

Limitations

  • Higher proportion of infants vs original PELD cohorts.

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