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 - 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
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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 -