Esmati, H. (Heda) (2020) Evaluation of pretransplant mortality of young patients with biliary atresia after introduction of the new allocation rule; a retrospective cohort study based on the Eurotransplant registry. thesis, Medicine.
Full text available on request.Abstract
Biliary atresia (BA) accounts for 71% of all liver transplantations in children below two years of age. To reduce the high waitlist mortality among these patients, Eurotransplant (ET) changed the priority rules for the allocation of donor livers. We aim to evaluate the effect of this new allocation rule on the wait-list mortality of young BA patients and also to analyze its effect on wait-list mortality in non-BA patients. Methods: We have conducted a retrospective cohort study on the outcomes of young BA patients listed for liver transplantation based on ET registry data. All patients listed for liver transplantation before their second birthday, between January 2001 and December 2018 were included in the study. In a two years follow-up, wait-list outcomes before (“Period A”) and after the implementation of the new allocation rule (“Period B”) were evaluated using competing risks analysis. The effect of age at listing and Model for End-Stage Liver Disease score at listing was assessed by performing a multivariable analysis. Results: A total of 1049 BA and 676 non-BA patients were included. Wait-list mortality in BA patients was significantly reduced in Period B (1.8%) when compared to Period A (6.7%; P=0.015). The wait-list mortality in non-BA patients reduced from 9.6% in Period A to 6.5% in Period B (P=0.328). No significant reduction in median time on the wait-list was seen for both BA and non-BA patients who received a Deceased Donor Liver Transplantation (DDLT) procedure. The percentage of Living Donor Liver Transplantation (LDLT) procedures significantly increased by 22% in BA patients between Period A and B (P=0.001). Conclusion: Wait-list mortality has decreased in BA patients since the new adjustments to the allocation rule, without negatively effecting the wait-list outcomes of non-BA patients. The robust increase in LDLT procedures likely plays the most important role in reducing wait-list mortality.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Verkade, Prof. dr. H.J. and Meijer, Dr. V.E. de |
| Faculty: | Medical Sciences |
| Date Deposited: | 16 Dec 2021 14:11 |
| Last Modified: | 16 Dec 2021 14:11 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2882 |
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