TY - JOUR
T1 - Liver simulated allocation model does not effectively predict organ offer decisions for pediatric liver transplant candidates
AU - Wood, Nicholas L.
AU - Mogul, Douglas B.
AU - Perito, Emily R.
AU - VanDerwerken, Douglas
AU - Mazariegos, George V.
AU - Hsu, Evelyn K.
AU - Segev, Dorry L.
AU - Gentry, Sommer E.
N1 - Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2021/9
Y1 - 2021/9
N2 - The SRTR maintains the liver-simulated allocation model (LSAM), a tool for estimating the impact of changes to liver allocation policy. Integral to LSAM is a model that predicts the decision to accept or decline a liver for transplant. LSAM implicitly assumes these decisions are made identically for adult and pediatric liver transplant (LT) candidates, which has not been previously validated. We applied LSAM's decision-making models to SRTR offer data from 2013 to 2016 to determine its efficacy for adult (≥18) and pediatric (<18) LT candidates, and pediatric subpopulations—teenagers (≥12 to <18), children (≥2 to <12), and infants (<2)—using the area under the receiver operating characteristic (ROC) curve (AUC). For nonstatus 1A candidates, all pediatric subgroups had higher rates of offer acceptance than adults. For non-1A candidates, LSAM's model performed substantially worse for pediatric candidates than adults (AUC 0.815 vs. 0.922); model performance decreased with age (AUC 0.898, 0.806, 0.783 for teenagers, children, and infants, respectively). For status 1A candidates, LSAM also performed worse for pediatric than adult candidates (AUC 0.711 vs. 0.779), especially for infants (AUC 0.618). To ensure pediatric candidates are not unpredictably or negatively impacted by allocation policy changes, we must explicitly account for pediatric-specific decision making in LSAM.
AB - The SRTR maintains the liver-simulated allocation model (LSAM), a tool for estimating the impact of changes to liver allocation policy. Integral to LSAM is a model that predicts the decision to accept or decline a liver for transplant. LSAM implicitly assumes these decisions are made identically for adult and pediatric liver transplant (LT) candidates, which has not been previously validated. We applied LSAM's decision-making models to SRTR offer data from 2013 to 2016 to determine its efficacy for adult (≥18) and pediatric (<18) LT candidates, and pediatric subpopulations—teenagers (≥12 to <18), children (≥2 to <12), and infants (<2)—using the area under the receiver operating characteristic (ROC) curve (AUC). For nonstatus 1A candidates, all pediatric subgroups had higher rates of offer acceptance than adults. For non-1A candidates, LSAM's model performed substantially worse for pediatric candidates than adults (AUC 0.815 vs. 0.922); model performance decreased with age (AUC 0.898, 0.806, 0.783 for teenagers, children, and infants, respectively). For status 1A candidates, LSAM also performed worse for pediatric than adult candidates (AUC 0.711 vs. 0.779), especially for infants (AUC 0.618). To ensure pediatric candidates are not unpredictably or negatively impacted by allocation policy changes, we must explicitly account for pediatric-specific decision making in LSAM.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - ethics and public policy
KW - health services and outcomes research
KW - liver transplantation/hepatology
KW - mathematical model
KW - organ acceptance
KW - organ allocation
KW - organ procurement and allocation
KW - pediatrics
KW - simulation
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U2 - 10.1111/ajt.16621
DO - 10.1111/ajt.16621
M3 - Article
C2 - 33891805
AN - SCOPUS:85105666472
SN - 1600-6135
VL - 21
SP - 3157
EP - 3162
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 9
ER -