Index to Predict Waiting Times for Pediatric Liver Transplantation

BACKGROUND: Hundreds of pediatric candidates are added to the liver transplant waitlist annually, yet wait times remain uncertain. This study identifies the variables associated with changes in wait time and creates a predictive points score to predict the likelihood of receiving a deceased-donor pediatric liver transplant within 1 year of listing. METHODS: A retrospective analysis of 5246 pediatric liver transplant candidates (2014-2024) was conducted using de-identified OPTN/UNOS data. Variables including demographics, lab values, and medical history were analyzed using univariate and multivariate logistic regression. Significant predictors from the multivariate model were used to develop a weighted points system, with model performance assessed via ROC analysis. RESULTS: 19 variables were statistically significant. The 3 significant variables most positively associated with receiving a transplant are: high volume transplant center (Odds Ratio [OR]: 3.79, p-value [p] < 0.001), Pacific Islander race (OR: 2.96, p = 0.049), and medium volume transplant center (OR: 2.53, p < 0.003). The 3 significant variables most negatively associated with receiving a transplant are: serum sodium > 150 mEq/L (OR: 0.37, p = 0.002), acute hepatic necrosis (OR: 0.53, p < 0.001), and bilirubin 1-2 mg/dL (OR: 0.68, p < 0.001). The model demonstrated moderate predictive accuracy (c-statistic = 0.66). CONCLUSION: This study identifies key predictors of pediatric liver transplant wait time and introduces a predictive scoring system to improve clinical decision-making. This tool provides a more accurate framework for identifying vulnerable candidates and can assist clinicians in pursuing technical variant or living donor options for those at highest risk of prolonged waitlist times.