What are we waiting for: Serious bacterial infections in children prior to liver transplant are associated with high morbidity but not expedited transplant

Bridget A Whitehead; Swati Antala; Anna M Banc-Husu; Katie Neighbors; Justin A Godown; Matt Hall; Cary Thurm; Sarah A Taylor; Estella M Alonso

doi:10.1002/jpn3.70130

What are we waiting for: Serious bacterial infections in children prior to liver transplant are associated with high morbidity but not expedited transplant

J Pediatr Gastroenterol Nutr. 2025 Jun 27. doi: 10.1002/jpn3.70130. Online ahead of print.

Authors

Bridget A Whitehead¹, Swati Antala², Anna M Banc-Husu³, Katie Neighbors¹, Justin A Godown⁴, Matt Hall⁵, Cary Thurm⁵, Sarah A Taylor⁶, Estella M Alonso¹

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA.
² Division of Pediatric Hepatology, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, New York, USA.
³ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁴ Department of Pediatrics, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
⁵ Children's Hospital Association, Lenexa, Kansas, USA.
⁶ Division of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA.

PMID: 40575941
DOI: 10.1002/jpn3.70130

Abstract

Objectives: Children with end-stage liver disease (ESLD) are at risk for complications including serious bacterial infections (SBI). We used the linkage of the Scientific Registry of Transplant Recipients (SRTR) and Pediatric Health Information System (PHIS) databases to examine frequency and morbidity of SBI and identify patient-specific risk factors.

Methods: We identified children listed for liver transplant between 2003 and 2019 who were hospitalized before transplant. Hospitalizations were characterized by SBI status using International Classification of Diseases (ICD) codes and healthcare utilization was compared using Chi-square and t tests. Univariate and multivariate logistic regression were performed to identify patient variables associated with pre-transplant SBI.

Results: A total of 1849 patients had 7601 hospitalizations and the majority (85%) were without SBI. Hospitalizations with SBI had longer length of stay (p < 0.001) and greater likelihood of needing therapies in the intensive care (p < 0.001). Almost one-third (32%) had hospitalization with SBI; in multivariate analysis, those with ascites (odds ratio [OR] 1.54 95% confidence interval [CI] 1.16-2.03) and nonprivate insurance (OR 1.40 95% CI 1.10-1.78) had higher odds of SBI. Patients with SBI had longer time on the waiting list (p = 0.023) despite being more likely to have approved exception (p = 0.006).

Conclusions: Despite experiencing a life-threatening complication of ESLD, patients with SBI do not undergo more expeditious transplant. They are more likely to have approved exception requests but have longer waitlist time. The current organ allocation system does not effectively prioritize these high-risk patients. SBI risk varies by insurance status, highlighting ongoing health disparities in pediatric transplantation.

Keywords: disparity; end‐stage liver disease; pediatric.

Grants and funding

5T32DK077662-14/NIH NIDDK