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Editorial
November 2018

Is the Pediatric End-stage Liver Disease Score Truly a Detriment to Pediatric Liver Allocation?

Author Affiliations
  • 1Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Clinical Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2018;172(11):1013-1015. doi:10.1001/jamapediatrics.2018.2886

In 2002, the United Network for Organ Sharing (UNOS) adopted the Pediatric End-stage Liver Disease (PELD) and Model for End-stage Liver Disease (MELD) scores to prioritize children and adults, respectively, who are waitlisted for a liver transplant.1 Both scores are computed from objective laboratory or measurement parameters that are intended to rank patients based on 90-day waitlist mortality, with higher scores meant to signify a higher risk of mortality (the calculated scores can exceed 40, but for ranking waitlisted patients, the scores cap at 40). Since the inception of MELD and PELD scoring, ensuring fairness of liver transplant allocation between children and adults has been of paramount importance, especially given that adult candidates substantially outnumber pediatric candidates on the waiting list.2 Prioritization on the waitlist incorporates a patient’s MELD or PELD score, along with additional considerations, including prioritizing pediatric patients for livers from pediatric recipients.

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