P69 Outcome of children on the UK national prioritised paediatric registration tier

Introduction

In April 2020 weekly teleconferences were established involving adult and paediatric representation from all 7 UK liver transplant (LT) centers and NHS England to discuss and maintain a national LT service during the COVID19 pandemic. Objective criteria for adult patients of high clinical urgency for prioritized access to LT were established. In lieu of such criteria for children, all three paediatric centers agreed to prioritize individual patients with chronic liver disease (CLD), who were clinically deteriorating, by consensus. A process to nationally prioritize clinically deteriorating children was successfully introduced in October 2020. We report on the utilization of the prioritization and outcome of these patients at a national level.

Methods

Patients from all 3 paediatric LT centers registered on the newly established national prioritised paediatric registration tier from October 2020-April 2022 were included. Demographic, clinical and laboratory data were collected and analyzed.

Results

Since the introduction of the prioritization tier for children there were fourteen UK elective applications and all approved registrations. Mean age of patients was 5 3.9 years (range, 0–17). All patients were listed for LT prior to prioritization except patient 5 and 9, listed for liver-small bowel transplant and for bowel transplantation before being prioritized for isolated LT, respectively. Indications for prioritization were hepatocellular carcinoma, acute decompensation due to portal hypertension, encephalopathy, sepsis, acute kidney injury, hepatic artery thrombosis, acute decompensation of CLD. At time of prioritization median values and range of alanine aminotransferase, albumin, total bilirubin, INR and platelets were 95 IU/L (23–453), 29 g/L (table 1).

Conclusion

The national paediatric prioritization tier, introduced during the COVID19 pandemic, has been a pivotal initiative for the UK paediatric LT program, showcasing national collaboration. All patients underwent a LT successfully within a short time from prioritization with 100% patient and graft survival. The intention is to maintain this prioritized paediatric tier beyond the pandemic.