Introduction: Pediatric liver transplantation provides substantial survival benefit. An emphasis on value-based practices has become a central theme in many surgical fields, but have not been well-studied in pediatric transplantation. Given an increasing focus on optimizing outcomes while containing costs, defining value in pediatric liver transplantation warrants investigation.
Methods: Pediatric end-stage liver disease -era deceased donor pediatric liver transplant recipients from 2/2002 to 2/2019 were identified using the United Network for Organ Sharing Standard Transplant Analysis file data (n = 5770). Liver centers were divided into volume tertiles (small, medium, and large), and recipients were stratified by age (0-4, 5-11, and 12-18 y). The value for the index transplant episode was defined as % graft survival ≥1 y divided by mean post-transplant length of stay. Nearest-neighbor Mahalanobis metric matching was used to account for confounding when assessing the impact of center volume on value.
Results: Compared to small centers, large centers delivered better outcomes (1-y graft survival 93.7% versus 89.4%, P = 0.017) without increased resource utilization (length of stay 20.8 ± 15.6 d versus 19.6 ± 17.0, P = 0.281) during the 17-y study period. Mahalanobois-matched cohorts demonstrated a volume-value relationship (higher value care with better outcomes and decreased resource utilization) in the 0-4 age group, but not in older recipients. The 0-4 age group comprised the largest proportion of status 1B patients (21.8%, P < 0.001) and the highest utilization rate of partial liver allografts (40.9%, P < 0.001).
Conclusions: There is value in liver transplant volume in very young (0-4 y) deceased donor pediatric patients. Given improved survival of these patients in higher volume centers, regionalization of care may benefit this specific population of recipients.
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http://dx.doi.org/10.1016/j.jss.2024.12.039 | DOI Listing |
Cell Transplant
January 2025
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Pediatric organ transplant recipients have a higher risk for wait list mortality due to the scarcity of size matched organs. Neonatal organ donation could potentially ameliorate the discrepancy but is currently not implemented in Sweden. This study aims to evaluate the potential of neonatal organ donation in central Sweden using a standardized protocol with organ specific criteria.
View Article and Find Full Text PDFNutrients
January 2025
Section of Preclinical Disease Biology, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark.
Children and teenagers display a distinct metabolic dysfunction-associated steatohepatitis (MASH) phenotype, yet studies of childhood MASH are scarce and validated animal models lacking, limiting the development of treatments. Poor vitamin C (VitC) status may affect MASH progression and often co-occurs with high-fat diets and related metabolic imbalances. As a regulator of DNA methylation, poor VitC status may further contribute to MASH by regulating gene expression This study investigated guinea pigs-a species that, like humans, depends on vitC in the diet-as a model of pediatric MASH, examining the effects of poor VitC status on MASH hallmarks and global DNA methylation levels.
View Article and Find Full Text PDFPathogens
January 2025
Department of Microbiology and Immunology, Faculty of Pharmacy, "Ovidius" University of Constanta, Str. Căpitan Aviator Al. Șerbănescu, nr.6, Campus Corp C, 900470 Constanta, Romania.
Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical records are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from Southeast Romania was performed, and 39 children and adolescents were included, aged 2-15 years old.
View Article and Find Full Text PDFPathogens
December 2024
Massachusetts General Brigham for Children, 175 Cambridge Street, Boston, MA 02114, USA.
Hepatitis C virus (HCV) infects both pediatric and adult populations and is an important cause of chronic liver disease worldwide. There are differences in the screening and management of HCV between pediatric and adult patients, which have been highlighted in this review. Direct-acting antiviral agents (DAA) have made the cure of HCV possible, and fortunately, these medications are approved down to three years of age.
View Article and Find Full Text PDFLife (Basel)
January 2025
Neurology Service, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" Iași University of Life Sciences, 700489 Iași, Romania.
Hepatic encephalopathy (HE) in dogs is a metabolic disorder of the central nervous system that occurs secondarily to liver dysfunctions, whether due to acquired or congenital causes. A portosystemic shunt is the presence of abnormal communications between the hepatic vessels (portal and suprahepatic veins). As a result of this, the blood brought from the digestive tract through the portal vein bypasses the liver, and the unmetabolized components of the portal bloodstream enter directly into systemic circulation, causing clinical symptoms of metabolic encephalopathy (HE).
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