Prevalence of a Composite Outcome to Capture Child and Liver Health One Year After Pediatric Liver Transplantation in the Starzl Network.

BACKGROUND

The Starzl Network for Excellence in Pediatric Transplantation, a learning health network focused on pediatric liver transplantation, identified optimizing immunosuppression as a priority challenge. There remains significant variability in immunosuppression practices across transplant centers and a need for comparative effectiveness research to clarify best practices. As a prelude, we aimed to develop a composite outcome that focuses on immunosuppression-related morbidity and to characterize its baseline prevalence at 1 year post-liver transplant.

METHODS

We developed a composite transplant primary outcome, based on a previously described "ideal outcome" definition utilized by the Society of Pediatric Liver Transplantation registry studies, with components reflecting liver and child health. We used retrospective data from Starzl Network centers to calculate the prevalence of achieving the composite outcome among children who underwent a liver transplant in 2023.

RESULTS

In 2023, 19 participating centers transplanted a total of 267 children. Of the 250 with complete data available, 46% were < 2 years of age at transplant, 25% were 2-8 years, 22% were > 8 years, and 7% were missing age data. Seventy-eight children (31%) achieved the composite outcome at 1 year, including 35% of < 2-year-olds, 32% of 2-8 year-olds, 29% of > 8 year-olds, and 11% without age available. The most common failed composite outcome criterion was having ALT > 50 IU/L at 1 year.

CONCLUSIONS

Only 31% of pediatric liver transplant recipients achieved the composite outcome by 1 year. Our network will aim to develop evidence-based best practices to increase achievement of the composite outcome by "right-sizing" immunosuppression for each child.