An international multicenter validation study of the Toronto listing criteria for pediatric intestinal transplantation

Amin J. Roberts, Paul W. Wales, Sue V. Beath, Helen M. Evans, Jonathan Hind, David Mercer, Theodoric Wong, Jason Yap, Christina Belza, Yaron Avitzur

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)2608-2615
Number of pages8
JournalAmerican Journal of Transplantation
Issue number11
StatePublished - Nov 2022


  • clinical decision-making
  • clinical research/practice
  • intestinal failure/injury
  • intestine/multivisceral transplantation
  • pediatrics

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


Dive into the research topics of 'An international multicenter validation study of the Toronto listing criteria for pediatric intestinal transplantation'. Together they form a unique fingerprint.

Cite this