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Similarities and Differences in Allocation Policies for Pediatric Liver Transplantation Across the World

Fischler, Björn*; Baumann, Ulrich; D’Agostino, Daniel; D’Antiga, Lorenzo§; Dezsofi, Antal||; Debray, Dominique; Durmaz, Ozlem#; Evans, Helen**; Frauca, Esteban††; Hadzic, Nedim‡‡; Jahnel, Jörg§§; Loveland, Jerome||||; McLin, Valérie¶¶; Ng, Vicky L.##; Nobili, Valerio***; Pawłowska, Joanna†††; Sharif, Khalid‡‡‡; Smets, Francoise§§§; Verkade, Henkjan J.||||||; Hsu, Evelyn¶¶¶; Horslen, Simon¶¶¶; Bucuvalas, John###

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 700–705
doi: 10.1097/MPG.0000000000002283
Original Articles: Hepatology

Objectives: We aimed to investigate national allocation policies for pediatric liver transplantation (LT).

Method: A survey was prepared by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Hepatology Committee in collaboration with the North American Studies of Pediatric Liver Transplantation consortium. The survey was sent to pediatric hepatologists and transplant surgeons worldwide. National data were obtained from centrally based registries.

Results: Replies were obtained from 15 countries from 5 of the world continents. Overall donation rate varied between 9 and 35 per million inhabitants. The number of pediatric LTs was 4 to 9 per million inhabitants younger than 18 years for 13 of the 15 respondents. In children younger than 2 years mortality on the waiting list (WL) varied between 0 and 20%. In the same age group, there were large differences in the ratio of living donor LT to deceased donor LT and in the ratio of split liver segments to whole liver. These differences were associated with possible discrepancies in WL mortality.

Conclusions: Similarities but also differences between countries were detected. The described data may be of importance when trying to reduce WL mortality in the youngest children.

*Department of Pediatrics, Karolinska University Hospital, Clintec, Stockholm, Sweden

Medizinische Hochschule Hannover, Paediatric Liver Unit, Hannover, Germany

Gastroenterology-Hepatology Division, Liver and Intestinal Transplantation Unit, Department of Pediatrics, Hospital Italiano, Buenos Aires, Argentina

§Hospital Papa Giovanni XXIII, Paediatric Hepatology, Gastroenterology and Transplantation, Bergamo, Italy

||First Department of Paediatrics, Semmelweis University, Budapest, Hungary

Hepatology Unit, Hôpital Necker-APHP, Paris, France

#Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Istanbul University, Istanbul, Turkey

**Department of Paediatric Gastroenterology, Starship Children's Hospital, Auckland, New Zealand

††Paediatric Hepatology and Liver Transplantation Unit, Hospital Universitario Infantil La Paz, Madrid, Spain

‡‡Paediatric Liver Unit, King's College Hospital, London, United Kingdom

§§Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria

||||Transplant Unit Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa

¶¶Department of Pediatrics, University Hospitals Geneva, Geneva, Switzerland

##Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada

***Pediatric Department, Hepatogastroenterology Unit, Bambino Gesù Hospital, University “La Sapienza”, – Rome, Italy

†††Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland

‡‡‡Birmingham Women's and Children's Hospital, Hepatobiliary and Transplantation, Birmingham, United Kingdom

§§§UCL, Cliniques Universitaires Saint-Luc, IREC, Pediatric Gastroenterology and Hepatology, Brussels, Belgium

||||||Department of Paediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

¶¶¶Seattle Children's Hospital, Seattle, WA

###Department of Pediatrics, Recanati/Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY.

Address correspondence and reprint requests to Björn Fischler, MD, PhD, Department of Pediatrics, Karolinska University Hospital, Clintec Karolinska Institutet, SE-14186 Stockholm, Sweden (e-mail:

Received 4 May, 2018

Accepted 22 December, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,