Can non-directed living liver donation help improve access to grafts and correct socioeconomic disparities in pediatric liver transplantation?
Corresponding Author
Dor Yoeli
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Correspondence
Dor Yoeli, Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Email: [email protected]
Search for more papers by this authorAmy G. Feldman
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorRashikh A. Choudhury
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorHunter B. Moore
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorShikha S. Sundaram
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorTrevor L. Nydam
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMichael E. Wachs
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorElizabeth A. Pomfret
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMegan A. Adams
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorWhitney E. Jackson
Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorCorresponding Author
Dor Yoeli
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Correspondence
Dor Yoeli, Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Email: [email protected]
Search for more papers by this authorAmy G. Feldman
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorRashikh A. Choudhury
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorHunter B. Moore
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorShikha S. Sundaram
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorTrevor L. Nydam
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMichael E. Wachs
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorElizabeth A. Pomfret
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMegan A. Adams
Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorWhitney E. Jackson
Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMegan A. Adams and Whitney E. Jackson co-senior authors.
Abstract
Background
Each year, children die awaiting LT as the demand for grafts exceeds the available supply. Candidates with public health insurance are significantly less likely to undergo both deceased donor LT and D-LLD LT. ND-LLD is another option to gain access to a graft. The aim of this study was to evaluate if recipient insurance type is associated with likelihood of D-LLD versus ND-LLD LT.
Methods
The SRTR/OPTN database was reviewed for pediatric LDLT performed between January 1, 2014 (Medicaid expansion era) and December 31, 2019 at centers that performed ≥1 ND-LLD LDLT during the study period. A multivariable logistic regression was performed to assess relationship between type of living donor (directed vs. non-directed) and recipient insurance.
Results
Of 299 pediatric LDLT, 46 (15%) were from ND-LLD performed at 18 transplant centers. Fifty-nine percent of ND-LLD recipients had public insurance in comparison to 40% of D-LLD recipients (p = .02). Public insurance was associated with greater odds of ND-LLD in comparison to D-LLD upon multivariable logistic regression (OR 2.37, 95% CI 1.23–4.58, p = .01).
Conclusions
ND-LLD allows additional children to receive LTs and may help address some of the socioeconomic disparity in pediatric LDLT, but currently account for only a minority of LDLT and are only performed at a few institutions. Initiatives to improve access to both D-LLD and ND-LLD transplants are needed.
CONFLICT OF INTEREST
The authors of this manuscript have no conflicts of interest to disclose as described by Pediatric Transplantation.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from SRTR/OPTN. Restrictions apply to the availability of these data. Data are available from the authors with the permission of SRTR/OPTN.
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