Table 1.
Clinical and transplant characteristics of liver transplant recipients, by initial NSER status*
| 1st NSER approved (n=997) | 1st NSER denied (n=141) | p* | |
|---|---|---|---|
| Female | 54.3% | 63.1% | 0.05 |
| Age at listing | 4.7 ± 5.7 | 10.8 ± 6.6 | 0.02 |
| ≤ 2 years | 55.3% | 19.9% | <0.001 |
| 2–12 years | 29.2% | 23.4% | |
| >12–18 years | 15.6% | 56.7% | |
| Weight (kg) at listing: median, IQR | 11.3 (6.7–28.1) | 40.8 (15.9–61.9) | <0.001 |
| Previous transplant (n=875) ¶ | 8.0% | 6.2% | 0.56 |
| Concurrently listed for kidney or pancreas | 3.8% | 9.9% | 0.001 |
| Ethnicity | |||
| White | 54.5% | 65.3% | 0.06 |
| Black | 17.4% | 9.2% | |
| Hispanic | 20.0% | 19.9% | |
| Asian | 5.2% | 4.3% | |
| Other | 3.0% | 1.4% | |
| Indication for liver transplant† | |||
| Biliary atresia | 49.7% | 25.5% | <0.001 |
| Cholestatic conditions | 11.9% | 19.2% | |
| Metabolic liver disease | 10.9% | 10.6% | |
| Tumor (outside standard criteria) | 5.4% | 8.5% | |
| Acute liver failure | 1.7% | 5.7% | |
| Other liver disease | 20.4% | 30.5% | |
| Public Insurance | 49.7% | 39.7% | 0.03 |
| Calculated MELD/PELD score at listing | 9 (2–16) | 11 (6–16) | 0.04 |
| Labs at listing | |||
| Creatinine (mg/dL) | 0.3 (0.2–0.47) | 0.52 (0.4–0.7) | <0.001 |
| Sodium | 137.2 ± 3.8 | 137.7 ± 3.55 | 0.11 |
| Albumin | 3.28 ± 0.73 | 3.23 ± 0.77 | 0.46 |
| INR | 1.2 (1.1–1.4) | 1.2 (1.1–1.4) | 0.91 |
| Bilirubin | 7.62 ± 7.98 | 5.92 ± 7.70 | 0.02 |
| Lab MELD/PELD score at 1st NSER | 10.1 ± 10.3 | 11.8 ± 9.8 | 0.06 |
| Requested MELD/PELD at 1st NSER | 29.0 ± 8.7 | 29.0 ± 5.7 | 0.95 |
| Center volume (mean number of pediatric liver transplants annually at listing center, 2009–2014) | |||
| <5 | 11.5% | 9.9% | 0.66 |
| 5–15 | 32.3% | 35.5% | |
| >15 | 49.0% | 49.6% | |
| Missing | 7.2% | 5.0% | |
| Days from listing to 1st NSER | 16 (2–70) | 27 (6–82) | 0.03 |
| Total days on waitlist* (n=1032) | 105 (47–210) | 148 (88–364) | <0.001 |
| Outcome of 1st listing during study period (n=1,032) | |||
| Transplanted | 90.6% | 79.7% | ‡ |
| Died/too sick | 5.5% | 8.6% | |
| Improved/lost to follow-up | 3.9% | 11.7% | |
| Lab MELD/PELD at waitlist removal (n=1,010) | 12.8 ± 12.3 | 14.6 ± 11.6 | 0.13 |
| Allocation MELD/PELD at waitlist removal (n=907) | 31.6 ± 10.0 | 25.3 ± 8.8 | <0.001 |
| Medical condition at transplant (n=921) | |||
| Not hospitalized | 65.6% | 66.7% | 0.99 |
| Hospitalized, not ICU | 20.4% | 19.6% | |
| ICU | 8.6% | 7.8% | |
| Not known | 5.5% | 5.9% | |
| Transplant Type (n=921) | |||
| Living donor | 8.1% | 8.8% | 0.95 |
| Cadaveric donor, whole | 70.9% | 70.6% | |
| Cadaveric donor, split | 16.1% | 14.7% | |
| Donor deceased after cardiac death (n=921) | 0.12% | 0% | 0.86 |
| Donor CDC high-risk (n=799) | 6.3% | 4.6% | 0.53 |
| Cold ischemia time (n=858)* | 6.8 ± 3.7 | 7.2 ± 3.6 | 0.30 |
Continuous variables reported as mean ± SD with p-value by ANOVA for variables with normal distribution, equal variances, median (IQR) with p-value by Kruskal-Wallis test for variables with skewed distribution and/or unequal variances (Bartlett’s test p<0.05). When included, (n) in each row indicates number of patients for whom data on that variable was available in the SRTR database. Rows without n listed had no missing data for that variable.
UNOS only includes previous transplant indicator on listings that end in liver transplant.
Cholestatic conditions include Alagille syndrome, Byler disease, progressive intrahepatic cholestatic syndromes, total parenteral nutrition cholestasis, sclerosing cholangitis, and idiopathic cholestasis. Metabolic liver disease includes alpha-1-antitrypsin deficiency, Crigler-Najjar syndrome, cystic fibrosis, glycogen storage disease, inborn errors in bile acid metabolism, neonatal hemochromatosis, primary hyperoxaluria, tyrosinemia, urea cycle defects, and Wilson’s disease. Other liver disease includes congenital hepatic fibrosis, Budd-Chiari syndrome, autoimmune hepatitis cirrhosis, drug toxicity, hepatitis C cirrhosis, and unknown cirrhosis.
See Results and Table 3, Supplemental Table 2 for statistical significance in analysis of waitlist mortality.