PMID- 34365719
OWN - NLM
STAT- MEDLINE
DCOM- 20220301
LR  - 20230509
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Print)
IS  - 1527-6465 (Linking)
VI  - 28
IP  - 3
DP  - 2022 Mar
TI  - Center Variability in Acute Rejection and Biliary Complications After Pediatric 
      Liver Transplantation.
PG  - 454-465
LID - 10.1002/lt.26259 [doi]
AB  - Transplant center performance and practice variation for pediatric post-liver 
      transplantation (LT) outcomes other than survival are understudied. This was a 
      retrospective cohort study of pediatric LT recipients who received transplants 
      between January 1, 2006, and May 31, 2017, using United Network for Organ Sharing 
      (UNOS) data that were merged with the Pediatric Health Information System 
      database. Center effects for the acute rejection rate at 1 year after LT (AR1) 
      using UNOS coding and the biliary complication rate at 1 year after LT (BC1) 
      using inpatient billing claims data were estimated by center-specific rescaled 
      odds ratios that accounted for potential differences in recipient and donor 
      characteristics. There were 2216 pediatric LT recipients at 24 freestanding 
      children's hospitals in the United States during the study period. The median 
      unadjusted center rate of AR1 was 36.92% (interquartile range [IQR], 
      22.36%-44.52%), whereas that of BC1 was 32.29% (IQR, 26.14%-40.44%). Accounting 
      for recipient case mix and donor factors, 5/24 centers performed better than 
      expected with regard to AR1, whereas 3/24 centers performed worse than expected. 
      There was less heterogeneity across the center effects for BC1 than for AR1. 
      There was no relationship observed between the center effects for AR1 or BC1 and 
      center volume. Beyond recipient and allograft factors, differences in transplant 
      center management are an important driver of center AR1 performance, and less so 
      of BC1 performance. Further research is needed to identify the sources of 
      variability so as to implement the most effective solutions to broadly enhance 
      outcomes for pediatric LT recipients.
CI  - Copyright (c) 2021 American Association for the Study of Liver Diseases.
FAU - Kanneganti, Mounika
AU  - Kanneganti M
AD  - Perelman School of Medicine University of Pennsylvania Philadelphia PA Department 
      of Biostatistics, Epidemiology and Informatics University of Pennsylvania 
      Philadelphia PA Center for Pediatric Clinical Effectiveness The Children's 
      Hospital of Philadelphia Philadelphia PA Division of Infectious Diseases The 
      Children's Hospital of Philadelphia Philadelphia PA Department of Surgery 
      University of Pennsylvania Philadelphia PA Division of Gastroenterology, 
      Hepatology and Nutrition The Children's Hospital of Philadelphia Philadelphia PA 
      Division of Gastroenterology and Hepatology University of Pennsylvania 
      Philadelphia PA.
FAU - Xu, Yuwen
AU  - Xu Y
FAU - Huang, Yuan-Shung
AU  - Huang YS
FAU - Kitt, Eimear
AU  - Kitt E
FAU - Fisher, Brian T
AU  - Fisher BT
FAU - Abt, Peter L
AU  - Abt PL
FAU - Rand, Elizabeth B
AU  - Rand EB
FAU - Schaubel, Douglas E
AU  - Schaubel DE
FAU - Bittermann, Therese
AU  - Bittermann T
LA  - eng
GR  - K08 DK117013/DK/NIDDK NIH HHS/United States
GR  - R01 DK070869/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20210825
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
SB  - IM
CIN - Liver Transpl. 2022 Mar;28(3):361-362. PMID: 34860459
MH  - Child
MH  - Databases, Factual
MH  - Graft Survival
MH  - Humans
MH  - *Liver Transplantation/adverse effects
MH  - Retrospective Studies
MH  - Tissue Donors
MH  - Transplant Recipients
MH  - United States/epidemiology
PMC - PMC8821725
MID - NIHMS1731781
COIS- Conflicts of interest: The authors of this manuscript firmly declare no conflicts 
      of interest related to this study.
EDAT- 2021/08/09 06:00
MHDA- 2022/03/03 06:00
PMCR- 2023/03/01
CRDT- 2021/08/08 21:11
PHST- 2021/07/09 00:00 [revised]
PHST- 2021/03/23 00:00 [received]
PHST- 2021/07/28 00:00 [accepted]
PHST- 2021/08/09 06:00 [pubmed]
PHST- 2022/03/03 06:00 [medline]
PHST- 2021/08/08 21:11 [entrez]
PHST- 2023/03/01 00:00 [pmc-release]
AID - 01445473-202203000-00016 [pii]
AID - 10.1002/lt.26259 [doi]
PST - ppublish
SO  - Liver Transpl. 2022 Mar;28(3):454-465. doi: 10.1002/lt.26259. Epub 2021 Aug 25.