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Split and LDLT in pediatric patients have the potential to decrease wait times and waitlist mortality. Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. The baseline characteristics and postoperative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Between 2010 and 2019, 911 pediatric LT were included in the analysis (LD graft group, n = 508, split graft group, n = 403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22–138) days vs. 46 (16–108) days; p = 0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p = 0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-, 3-, and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10 kg or ≤10 years old receiving an LD graft showed improved graft survival. In conclusion, LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes. [ABSTRACT FROM AUTHOR]

Summary: The impact of hyponatremia on waitlist and post‐transplant outcomes following the implementation of MELD‐Na‐based liver allocation remains unclear. We investigated waitlist and postliver transplant (LT) outcomes in patients with hyponatremia before and after implementing MELD‐Na‐based allocation. Adult patients registered for a primary LT between 2009 and 2021 were identified in the OPTN/UNOS database. Two eras were defined; pre‐MELD‐Na and post‐MELD‐Na. Extreme hyponatremia was defined as a serum sodium concentration ≤120 mEq/l. Ninety‐day waitlist outcomes and post‐LT survival were compared using Fine‐Gray proportional hazard and mixed‐effects Cox proportional hazard models. A total of 118 487 patients were eligible (n = 64 940: pre‐MELD‐Na; n = 53 547: post‐MELD‐Na). In the pre‐MELD‐Na era, extreme hyponatremia at listing was associated with an increased risk of 90‐day waitlist mortality ([ref: 135–145] HR: 3.80; 95% CI: 2.97–4.87; P < 0.001) and higher transplant probability (HR: 1.67; 95% CI: 1.38–2.01; P < 0.001). In the post‐MELD‐Na era, patients with extreme hyponatremia had a proportionally lower relative risk of waitlist mortality (HR: 2.27; 95% CI 1.60–3.23; P < 0.001) and proportionally higher transplant probability (HR: 2.12; 95% CI 1.76–2.55; P < 0.001) as patients with normal serum sodium levels (135–145). Extreme hyponatremia was associated with a higher risk of 90, 180, and 365‐day post‐LT survival compared to patients with normal serum sodium levels. With the introduction of MELD‐Na‐based allocation, waitlist outcomes have improved in patients with extreme hyponatremia but they continue to have worse short‐term post‐LT survival. [ABSTRACT FROM AUTHOR]

Summary: Heart transplantation is a viable option for end stage heart disease but long‐term complications such as chronic kidney disease are being increasingly recognized. We sought to investigate the effect of change in estimated glomerular filtration rate (eGFR) during the heart transplant waitlist period on post‐transplant mortality and end stage kidney disease (ESKD). We analysed the United Network of Organ Sharing heart transplant database from 2000 to 2017. Multivariable Cox regression with restricted cubic splines and cumulative incidence competing risk (CICR) methods were used to compare the effects of change in eGFR on mortality and ESKD, respectively. A total of 19 412 patients met our inclusion criteria. Mortality increased with increasing loss of eGFR (adjusted hazard ratio increased from 1.02 [confidence interval (CI) 1.01–1.04, P = 0.008] for 10% loss to 1.15 (CI 1.06–1.26, P = 0.001) for 50% loss of eGFR. Similarly, risk of ESKD also increased monotonically with increasing loss of renal function [subdistribution hazard ratio increased from 1.12 (CI 1.09–1.14, P < 0.001) to 2.0 (CI 1.74–2.3, P < 0.001)] as loss of eGFR increased from 10% to 50%. Overall, we found that loss of >10% of eGFR resulted in higher risk of mortality and higher risk of ESKD. [ABSTRACT FROM AUTHOR]