{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:23:39Z","timestamp":1791908619235,"version":"4.3.4"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:p>Patients with biliary atresia (BA) below 2\u2009years of age in need of a transplantation largely rely on partial grafts from deceased donors (deceased donor liver transplantation [DDLT]) or living donors (living donor liver transplantation [LDLT]). Because of high waitlist mortality in especially young patients with BA, the Eurotransplant Liver Intestine Advisory Committee (ELIAC) has further prioritized patients with BA listed before their second birthday for allocation of a deceased donor liver since 2014. We evaluated whether this Eurotransplant (ET) allocation prioritization changed the waitlist mortality of young patients with BA. We used a pre\u2013post cohort study design with the implementation of the new allocation rule between the two periods. Participants were patients with BA younger than 2\u2009years who were listed for liver transplantation in the ET database between 2001 and 2018. Competing risk analyses were performed to assess waitlist mortality in the first 2\u2009years after listing. We analyzed a total of 1055 patients with BA, of which 882 had been listed in the preimplementation phase (PRE) and 173 in the postimplementation phase (POST). Waitlist mortality decreased from 6.7% in PRE to 2.3% in POST (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.03). Interestingly, the proportion of young patients with BA undergoing DDLT <jats:italic toggle=\"yes\">decreased<\/jats:italic> from 32% to 18% after ET allocation prioritization (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.001), whereas LDLT <jats:italic toggle=\"yes\">increased<\/jats:italic> from 55% to 74% (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.001). The proportional increase in LDLT decreased the median waitlist duration of transplanted patients from 1.5\u2009months in PRE to 0.85\u2009months in POST (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.003). Since 2014, waitlist mortality in young patients with BA has strongly decreased in the ET region. Rather than associated with prioritized allocation of deceased donor organs, the decreased waitlist mortality was related to a higher proportion of patients undergoing LDLT.<\/jats:p>","DOI":"10.1002\/lt.26529","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T01:33:50Z","timestamp":1655256830000},"page":"157-163","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Waitlist mortality of young patients with biliary atresia: Impact of allocation policy and living donor liver transplantation"],"prefix":"10.1097","volume":"29","author":[{"given":"Hedayatullah","family":"Esmati","sequence":"first","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"van Rosmalen","sequence":"additional","affiliation":[{"name":"Eurotransplant International Foundation, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick F.","family":"van Rheenen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke T.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aad P.","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert P. J.","family":"van der Doef","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Rayar","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben H.J.","family":"de Kleine","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Porte","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7900-5917","authenticated-orcid":false,"given":"Vincent E.","family":"de Meijer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7034-2861","authenticated-orcid":false,"given":"Henkjan J.","family":"Verkade","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"lt26529-bib-0001-20250824","article-title":"Outcomes of adults who received liver transplant as young children","volume":"38","year":"2021","journal-title":"EClinMed"},{"key":"lt26529-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/S0140-6736(09)60946-6","article-title":"Biliary atresia","volume":"374","year":"2009","journal-title":"Lancet"},{"key":"lt26529-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/ajt.14489","article-title":"Living donor liver transplantation for biliary atresia: an analysis of 2085 cases in the registry of the Japanese liver transplantation society","volume":"18","year":"2018","journal-title":"Am J Transplant"},{"key":"lt26529-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1002\/lt.25025","article-title":"Wait\u2010list mortality of young patients with biliary atresia: competing risk analysis of a Eurotransplant registry\u2010based cohort","volume":"24","year":"2018","journal-title":"Liver Transpl"},{"key":"lt26529-bib-0006-20250824","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/EDE.0b013e3181577654","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"18","year":"2007","journal-title":"Epidemiology"},{"key":"lt26529-bib-0007-20250824","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk","volume":"94","year":"1999","journal-title":"J Am Stat Assoc"},{"key":"lt26529-bib-0008-20250824","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1002\/hep.32223","article-title":"European liver transplant registry: donor and transplant surgery aspects of 16,641 liver transplantations in children","volume":"75","year":"2022","journal-title":"Hepatology"},{"key":"lt26529-bib-0009-20250824","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1002\/lt.26250","article-title":"Long\u2010term outcomes of pediatric living versus deceased donor liver transplantation recipients: a systematic review and meta\u2010analysis","volume":"28","year":"2022","journal-title":"Liver Transpl"},{"key":"lt26529-bib-0010-20250824","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1111\/ajt.15300","article-title":"A national mandatory\u2010split liver policy: a report from the Italian experience","volume":"19","year":"2019","journal-title":"Am J Transplant"},{"key":"lt26529-bib-0011-20250824","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1097\/TP.0000000000003079","article-title":"Impact of acuity circles on outcomes for pediatric liver transplant candidates","volume":"104","year":"2020","journal-title":"Transplantation"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lt.26529","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lt.26529","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.26529","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T20:04:06Z","timestamp":1756065846000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.26529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.26529","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1,17]]},"assertion":[{"value":"2022-04-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}