TY - JOUR
T1 - An international multicenter validation study of the Toronto listing criteria for pediatric intestinal transplantation
AU - Roberts, Amin J.
AU - Wales, Paul W.
AU - Beath, Sue V.
AU - Evans, Helen M.
AU - Hind, Jonathan
AU - Mercer, David
AU - Wong, Theodoric
AU - Yap, Jason
AU - Belza, Christina
AU - Avitzur, Yaron
N1 - Funding Information:
The authors of this manuscript have conflicts of interest to disclose as described by the . Amin J Roberts: Nestle Nutrition Scientific Advisory Panel. Paul W Wales: Research funding support from Takeda, VectivBio, Baxter Pharmaceuticals. Sue V Beath: None. Helen M Evans: Nestle Nutrition Scientific Advisory Panel. Jonathan Hind: None. David Mercer:. Theodoric Wong: Previous honorarium from Fresenius Kabi. Jason Yap: Takeda Advisory Board Committee. Christina Belza: None. Yaron Avitzur: Takeda advisory board and research funding support; Zealand Pharma consultant; IPSEN consultant. American Journal of Transplantation
Funding Information:
This study was presented at the Pediatric Intestinal Failure and Rehabilitation Symposium, Pittsburgh, USA, September 20–22, 2018 (AJR was the recipient of a Top Abstract Presentation award), the American Transplant Congress, Boston, USA, June 1–5, 2019, and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition Annual Scientific Meeting, Glasgow, UK, June 5–8, 2019 (AJR was the recipient of a Young Investigator Award). AJR is the recipient of an Astellas Research Grant from the Transplant & Regenerative Medicine Centre at the Hospital for Sick Children, Toronto, Canada.
Publisher Copyright:
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2022/11
Y1 - 2022/11
N2 - Deciding which patients would benefit from intestinal transplantation (IT) remains an ethical/clinical dilemma. New criteria* were proposed in 2015: ≥2 intensive care unit (ICU) admissions, loss of ≥3 central venous catheter (CVC) sites, and persistently elevated conjugated bilirubin (CB ≥ 75 μmol/L) despite 6 weeks of lipid modification strategies. We performed a retrospective, international, multicenter validation study of 443 children (61% male, median gestational age 34 weeks [IQR 29–37]), diagnosed with IF between 2010 and 2015. Primary outcome measure was death or IT. Sensitivity, specificity, NPV, PPV, and probability of death/transplant (OR, 95% confidence intervals) were calculated for each criterion. Median age at IF diagnosis was 0.1 years (IQR 0.03–0.14) with median follow-up of 3.8 years (IQR 2.3–5.3). Forty of 443 (9%) patients died, 53 of 443 (12%) were transplanted; 11 died posttransplant. The validated criteria had a high predictive value of death/IT; ≥2 ICU admissions (p <.0001, OR 10.2, 95% CI 4.0–25.6), persistent CB ≥ 75 μmol/L (p <.0001, OR 8.2, 95% CI 4.8–13.9). and loss of ≥3 CVC sites (p =.0003, OR 5.7, 95% CI 2.2–14.7). This large, multicenter, international study in a contemporary cohort confirms the validity of the Toronto criteria. These validated criteria should guide listing decisions in pediatric IT.
AB - Deciding which patients would benefit from intestinal transplantation (IT) remains an ethical/clinical dilemma. New criteria* were proposed in 2015: ≥2 intensive care unit (ICU) admissions, loss of ≥3 central venous catheter (CVC) sites, and persistently elevated conjugated bilirubin (CB ≥ 75 μmol/L) despite 6 weeks of lipid modification strategies. We performed a retrospective, international, multicenter validation study of 443 children (61% male, median gestational age 34 weeks [IQR 29–37]), diagnosed with IF between 2010 and 2015. Primary outcome measure was death or IT. Sensitivity, specificity, NPV, PPV, and probability of death/transplant (OR, 95% confidence intervals) were calculated for each criterion. Median age at IF diagnosis was 0.1 years (IQR 0.03–0.14) with median follow-up of 3.8 years (IQR 2.3–5.3). Forty of 443 (9%) patients died, 53 of 443 (12%) were transplanted; 11 died posttransplant. The validated criteria had a high predictive value of death/IT; ≥2 ICU admissions (p <.0001, OR 10.2, 95% CI 4.0–25.6), persistent CB ≥ 75 μmol/L (p <.0001, OR 8.2, 95% CI 4.8–13.9). and loss of ≥3 CVC sites (p =.0003, OR 5.7, 95% CI 2.2–14.7). This large, multicenter, international study in a contemporary cohort confirms the validity of the Toronto criteria. These validated criteria should guide listing decisions in pediatric IT.
KW - clinical decision-making
KW - clinical research/practice
KW - intestinal failure/injury
KW - intestine/multivisceral transplantation
KW - pediatrics
UR - http://www.scopus.com/inward/record.url?scp=85141112812&partnerID=8YFLogxK
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U2 - 10.1111/ajt.17150
DO - 10.1111/ajt.17150
M3 - Article
C2 - 35833730
AN - SCOPUS:85141112812
SN - 1600-6135
VL - 22
SP - 2608
EP - 2615
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -