Journal Article

P69 Outcome of children on the UK national prioritised paediatric registration tier

Grammatikopoulos, Tassos, Manas, Derek, Watson, Miss Sarah, Heaton, Nigel, Mirza, Doctor Darius, Dixit, Shweta, Forsythe, John, Hartley, Doctor Jane, Taylor, Miss Rhiannon, Whitney, Miss Julie, Isaac, Doctor John, Prasad, Doctor Raj, Thorburn, Doug, Dhawan, Anil, Rajwal, Doctor Sanjay

2022

Overview

IntroductionIn April 2020 weekly teleconferences were established involving adult and paediatric representation from all 7 UK liver transplant (LT) centers and NHS England to discuss and maintain a national LT service during the COVID19 pandemic. Objective criteria for adult patients of high clinical urgency for prioritized access to LT were established. In lieu of such criteria for children, all three paediatric centers agreed to prioritize individual patients with chronic liver disease (CLD), who were clinically deteriorating, by consensus. A process to nationally prioritize clinically deteriorating children was successfully introduced in October 2020. We report on the utilization of the prioritization and outcome of these patients at a national level.MethodsPatients from all 3 paediatric LT centers registered on the newly established national prioritised paediatric registration tier from October 2020-April 2022 were included. Demographic, clinical and laboratory data were collected and analyzed.ResultsSince the introduction of the prioritization tier for children there were fourteen UK elective applications and all approved registrations. Mean age of patients was 5 3.9 years (range, 0–17). All patients were listed for LT prior to prioritization except patient 5 and 9, listed for liver-small bowel transplant and for bowel transplantation before being prioritized for isolated LT, respectively. Indications for prioritization were hepatocellular carcinoma, acute decompensation due to portal hypertension, encephalopathy, sepsis, acute kidney injury, hepatic artery thrombosis, acute decompensation of CLD. At time of prioritization median values and range of alanine aminotransferase, albumin, total bilirubin, INR and platelets were 95 IU/L (23–453), 29 g/L (table 1).Abstract P69 Table 1Demographic and transplant data for all 14 prioritised patients Patient/Sex Centre Age at registration (yrs) Primary liver disease Registered prior to Prioritisation Indication of Prioritization LT Waiting time on prioritised tier/Time on list prior to prioritisation 1/M 1 0 CDG Yes Acute decompensation with presence of encephalopathy Yes/LLS 5/27 2/M 2 1 Cryptogenic Cirrhosis Yes CLD with nodular lesions s/o HCC Yes/LLS 16/48 3/F 1 15 AILD Yes Chronic rejection Yes/whole liver 3/4 4/M 2 0 Biliary Atresia Yes PTLD/HAT/Sepsis Yes/LLS 14/71 5/F 2 4 IFALD No Coagulopathy with active bleeding/Renal impairment Yes/LLS 15/820 6/F 2 0 Biliary Atresia Yes Acute decompensation due to portal hypertension Yes/LLS 37/405 7/M 2 10 NSC Yes Decompensated chronic liver disease/Renal impairment Yes/reduced R lobe 4/7 8/M 3 8 PFIC3 Yes Acute decompensation of Chronic liver disease Yes/LLS 6/51 9/F 1 0 Other(Hepatoblastoma) Intestinal Tx prioritized Acute decompensation of Chronic liver disease Yes/LLS 11/ 10/F 2 0 Biliary atresia Yes Decompensated Chronic Liver Disease with Severe Coagulopathy Yes/LLS 10/120 11/M 1 0 Biliary atresia(Hepatoblastoma) Yes Acute decompensation of Chronic liver disease Yes/LLS 9/4 12/F 3 0 Biliary atresia Yes Acute decompensation of Chronic liver disease Yes/LLS 12/323 13/F 1 17 Hepatic Artery thrombosis Yes Hepatic Artery thrombosis Yes/whole liver 2/ 14/F 2 0 Biliary atresia Yes Acute decompensation of Chronic liver disease Suspended 12/65 PFIC3; Progressive Familial Intrahepatic Cholestasis type 3, LT; Liver transplantation, HCC; Hepatocellular Carcinoma NSC; Neonatal Sclerosing Cholangitis, CDG; Congenital Disorder of Glycosylation, AILD; Autoimmune Liver Disease, IFALD; Intestinal Failure Associated Liver Disease,PTLD; Center 1-Kings; Center2-Birmingham; Center3-Leeds.ConclusionThe national paediatric prioritization tier, introduced during the COVID19 pandemic, has been a pivotal initiative for the UK paediatric LT program, showcasing national collaboration. All patients underwent a LT successfully within a short time from prioritization with 100% patient and graft survival. The intention is to maintain this prioritized paediatric tier beyond the pandemic.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Abstracts / Alanine / Alanine transaminase / Biliary atresia / Bilirubin / Children / Cholangitis / Cholestasis / Cirrhosis / Demography / Encephalopathy / Glycosylation / Graft rejection / Hepatic artery / Hepatocellular carcinoma / Hypertension / Liver cancer / Liver cirrhosis / Liver diseases / Liver transplantation / Neonates / Pandemics / Patients / Pediatrics / Posttransplant lymphoproliferative disorders / Registration / Sepsis / Small intestine transplantation / Thrombosis / Transplants & implants