An international multicenter validation study of the Toronto listing criteria for pediatric intestinal transplantation. Issue 11 (1st August 2022)

• Record Type: Journal Article
• Authors: Roberts, Amin J.; Wales, Paul W.; Beath, Sue V.; Evans, Helen M.; Hind, Jonathan; Mercer, David; Wong, Theodoric; Yap, Jason; Belza, Christina; Avitzur, Yaron
• Is Part Of: American journal of transplantation. Volume 22:Issue 11(2022)
• Page Start: 2608
• Page End: 2615
• Publication Date: 2022-08-01
• Subjects: clinical decision‐making -- clinical research/practice -- intestinal failure/injury -- intestine/multivisceral transplantation -- pediatrics; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.17150
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract: Deciding which patients would benefit from intestinal transplantation (IT) remains an ethical/clinical dilemma. New criteria* were proposed in 2015: ≥2 intensive care unit (ICU) admissions, loss of ≥3 central venous catheter (CVC) sites, and persistently elevated conjugated bilirubin (CB ≥ 75 μmol/L) despite 6 weeks of lipid modification strategies. We performed a retrospective, international, multicenter validation study of 443 children (61% male, median gestational age 34 weeks [IQR 29–37]), diagnosed with IF between 2010 and 2015. Primary outcome measure was death or IT. Sensitivity, specificity, NPV, PPV, and probability of death/transplant (OR, 95% confidence intervals) were calculated for each criterion. Median age at IF diagnosis was 0.1 years (IQR 0.03–0.14) with median follow‐up of 3.8 years (IQR 2.3–5.3). Forty of 443 (9%) patients died, 53 of 443 (12%) were transplanted; 11 died posttransplant. The validated criteria had a high predictive value of death/IT; ≥2 ICU admissions ( p < .0001, OR 10.2, 95% CI 4.0–25.6), persistent CB ≥ 75 μmol/L ( p < .0001, OR 8.2, 95% CI 4.8–13.9). and loss of ≥3 CVC sites ( p = .0003, OR 5.7, 95% CI 2.2–14.7). This large, multicenter, international study in a contemporary cohort confirms the validity of the Toronto criteria. These validated criteria should guide listing decisions in pediatric IT. Abstract : This international multicentre study encompassing a large contemporary cohort of children with intestinal failure validates three listing criteria: a conjugated bilirubin of more than 75 µmol/L for eight weeks despite lipid modification strategies, two or more admissions to ICU, and a loss of three or more central venous catheter sites.