An International Multicenter Validation Study of the Toronto Listing Criteria for Pediatric Intestinal Transplantation

Deciding which patients would benefit from intestinal transplantation (IT) remains an ethical/clinical dilemma. New criteria* were proposed in 2015: >= 2 intensive care unit (ICU) admissions, loss of >= 3 central venous catheter (CVC) sites, and persistently elevated conjugated bilirubin (CB >= 75 mu mol/L) despite 6 weeks of lipid modification strategies. We performed a retrospective, international, multicenter validation study of 443 children (61% male, median gestational age 34 weeks [IQR 29-37]), diagnosed with IF between 2010 and 2015. Primary outcome measure was death or IT. Sensitivity, specificity, NPV, PPV, and probability of death/transplant (OR, 95% confidence intervals) were calculated for each criterion. Median age at IF diagnosis was 0.1 years (IQR 0.03-0.14) with median follow-up of 3.8 years (IQR 2.3-5.3). Forty of 443 (9%) patients died, 53 of 443 (12%) were transplanted; 11 died posttransplant. The validated criteria had a high predictive value of death/IT; >= 2 ICU admissions (p < .0001, OR 10.2, 95% CI 4.0-25.6), persistent CB >= 75 mu mol/L (p < .0001, OR 8.2, 95% CI 4.8-13.9). and loss of >= 3 CVC sites (p = .0003, OR 5.7, 95% CI 2.2-14.7). This large, multicenter, international study in a contemporary cohort confirms the validity of the Toronto criteria. These validated criteria should guide listing decisions in pediatric IT.