Liver simulated allocation model does not effectively predict organ offer decisions for pediatric liver transplant candidates

Nicholas L. Wood, Douglas B. Mogul, Emily R. Perito, Douglas VanDerwerken, George V. Mazariegos, Evelyn K. Hsu, Dorry L. Segev, Sommer E. Gentry

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)3157-3162
Number of pages6
JournalAmerican Journal of Transplantation
Issue number9
StatePublished - Sep 2021


  • Scientific Registry for Transplant Recipients (SRTR)
  • ethics and public policy
  • health services and outcomes research
  • liver transplantation/hepatology
  • mathematical model
  • organ acceptance
  • organ allocation
  • organ procurement and allocation
  • pediatrics
  • simulation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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