Waiting list and post-transplant outcomes in children and young adults with liver transplantation: an analysis of the information registry and management system of Argentina (SINTRA)
Viviana Tagliafichi1, Marcelo Dip2, Ariel Antik1, Liliana Bisigniano1.
1Scientific and Technical Direction, INCUCAI, Buenos Aires, Argentina; 2Liver Trasnplantion Comittee, Argentine Transplantation Society, Buenos Aires, Argentina
Introduction: The pediatric population of Argentina, especially those under 12 years old, access to liver transplantation through the MELD score exception. This fact might cause inequities since young adult’s recipients are at high risk factor for worse graft survival after liver transplantation. In this study we evaluated liver transplantation waitlist and post-transplant outcomes in those aged 18 to 24 years compared to younger waitlist registrants and recipients.
Method: we performed a multivariate logistic regression to examinate the association between age at listing (0-5, 6-11,12-17 and 18 -24 years [the reference category]) and waitlist outcomes: drop out and transplantation. The model included the following features: emergency category, whether an exception score was granted, serum albumin, ABO blood group, and insurance payer status. The database used was the Information Registry and Management System of Argentina (SINTRA). Graft and patient survival were stratified by these age categories using Kaplan Meier curves to perform the analysis of transplant outcomes.
Results: between 2006 and 2020, 1842 on first time transplants registrants and 794 recipients were included. Registrants aged 0 to 17 were less likely to experience dropout from the waiting list compared with those aged 18 to 24 years (adjusted hazard ratio, 0-5: OR 0.21 (0.16-0.30); 6-11: OR 0.36 (0.22-0.59); 12-17: 0.57 (0.39-0.86); 18-24: 1.00), and better transplant probability (adjusted hazard ratio, 0-5: OR 4.20 (3.03-5.82); 6-11: OR 2.10 (1.33-3.31);12-17: 1.36 (0.90-2); 18-24: 1.00). In post-liver transplant survival analysis, recipients aged 18 to 24 years had a similar risk of graft failure and death compared with all other groups.
Conclusion: This study showed that there was not differences in liver graft failure and death between young adults ages 18 to 24 years and children. However, younger age liver transplant patients had had higher probability of drop out from the waitlist and less probability of being transplanted compared to younger age groups.
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