{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:21:24Z","timestamp":1793809284738,"version":"4.6.1"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"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":[[2023,7]]},"abstract":"<jats:p>To assess the impact of technical variant grafts (TVGs) [including living donor (LD) and deceased donor split\/partial grafts] on waitlist (WL) and transplant outcomes for pediatric liver transplant (LT) candidates, we performed a retrospective analysis of Organ Procurement and Transplantation Network (OPTN) data on first-time LT or liver-kidney pediatric candidates listed at centers that performed &gt;10 LTs during the study period, 2004\u20132020. Center variance was plotted for LT volume, TVG usage, and survival. A composite center metric of TVG usage and WL mortality was developed to demonstrate the existing variation and potential for improvement. Sixty-four centers performed 7842 LTs; 657 children died on the WL. Proportions of WL mortality by center ranged from 0% to 31% and those of TVG usage from 0% to 76%. Higher TVG usage, from deceased donor or LD, independently or in combination, significantly correlated with lower WL mortality. In multivariable analyses, death from listing was significantly lower with increased center TVG usage (HR = 0.611, CI: 0.40\u20130.92) and LT volume (HR = 0.995, CI: 0.99\u20131.0). Recipients of LD transplants (HR = 0.637, CI: 0.51\u20130.79) had significantly increased survival from transplant compared with other graft types, and recipients of deceased donor TVGs (HR = 1.066, CI: 0.93\u20131.22) had statistically similar outcomes compared with whole graft recipients. Increased TVG utilization may decrease WL mortality in the US. Hence, policy and training to increase TVG usage, availability, and expertise are critical.<\/jats:p>","DOI":"10.1097\/lvt.0000000000000091","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T19:00:12Z","timestamp":1675710012000},"page":"671-682","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":40,"title":["Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States"],"prefix":"10.1097","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-8632","authenticated-orcid":false,"given":"George V.","family":"Mazariegos","sequence":"first","affiliation":[{"name":"Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-9684","authenticated-orcid":false,"given":"Emily R.","family":"Perito","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6979-8987","authenticated-orcid":false,"given":"James E.","family":"Squires","sequence":"additional","affiliation":[{"name":"Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0899-7234","authenticated-orcid":false,"given":"Kyle A.","family":"Soltys","sequence":"additional","affiliation":[{"name":"Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children\u2019s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4894-2024","authenticated-orcid":false,"given":"Adam D.","family":"Griesemer","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3575-8386","authenticated-orcid":false,"given":"Sarah A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8635-3012","authenticated-orcid":false,"given":"Eric","family":"Pahl","sequence":"additional","affiliation":[{"name":"Health Informatics, University of Iowa, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"R1-20250824","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/lt.24646","article-title":"Global lessons in graft type and pediatric liver allocation: a path toward improving outcomes and eliminating wait-list mortality","volume":"23","author":"Hsu","year":"2017","journal-title":"Liver Transpl"},{"issue":"suppl 2","key":"R2-20250824","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/ajt.16494","article-title":"OPTN\/SRTR 2019 Annual Data Report: 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