{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:58:43Z","timestamp":1790413123314,"version":"4.1.0"},"reference-count":11,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Starzl Network for Excellence in Pediatric Transplantation, a learning health network focused on pediatric liver transplantation, identified optimizing immunosuppression as a priority challenge. There remains significant variability in immunosuppression practices across transplant centers and a need for comparative effectiveness research to clarify best practices. As a prelude, we aimed to develop a composite outcome that focuses on immunosuppression\u2010related morbidity and to characterize its baseline prevalence at 1\u2009year post\u2010liver transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a composite transplant primary outcome, based on a previously described \u201cideal outcome\u201d definition utilized by the Society of Pediatric Liver Transplantation registry studies, with components reflecting liver and child health. We used retrospective data from Starzl Network centers to calculate the prevalence of achieving the composite outcome among children who underwent a liver transplant in 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2023, 19 participating centers transplanted a total of 267 children. Of the 250 with complete data available, 46% were &lt;\u20092\u2009years of age at transplant, 25% were 2\u20138\u2009years, 22% were &gt;\u20098\u2009years, and 7% were missing age data. Seventy\u2010eight children (31%) achieved the composite outcome at 1\u2009year, including 35% of &lt;\u20092\u2010year\u2010olds, 32% of 2\u20138\u2009year\u2010olds, 29% of &gt;\u20098\u2009year\u2010olds, and 11% without age available. The most common failed composite outcome criterion was having ALT &gt;\u200950\u2009IU\/L at 1\u2009year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Only 31% of pediatric liver transplant recipients achieved the composite outcome by 1\u2009year. Our network will aim to develop evidence\u2010based best practices to increase achievement of the composite outcome by \u201cright\u2010sizing\u201d immunosuppression for each child.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70402","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T08:21:12Z","timestamp":1783758072000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of a Composite Outcome to Capture Child and Liver Health One Year After Pediatric Liver Transplantation in the Starzl Network"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2344-626X","authenticated-orcid":false,"given":"Frank","family":"DiPaola","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics University of Virginia  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4021-5615","authenticated-orcid":false,"given":"Amy","family":"Feldman","sequence":"additional","affiliation":[{"name":"Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute University of Colorado School of Medicine and Children's Hospital Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9998-5692","authenticated-orcid":false,"given":"Vicky","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7175-9792","authenticated-orcid":false,"given":"Swati","family":"Antala","sequence":"additional","affiliation":[{"name":"Mount Sinai Kravis Children's Hospital and Recanati\/Miller Transplantation Institute Mount Sinai Health System  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6767-8874","authenticated-orcid":false,"given":"John","family":"Bucuvalas","sequence":"additional","affiliation":[{"name":"Mount Sinai Kravis Children's Hospital and Recanati\/Miller Transplantation Institute Mount Sinai Health System  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4494-1729","authenticated-orcid":false,"given":"Noelle","family":"Ebel","sequence":"additional","affiliation":[{"name":"Stanford University  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6171-4731","authenticated-orcid":false,"given":"Nitika","family":"Gupta","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta and Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8447-9068","authenticated-orcid":false,"given":"Jennifer","family":"Halma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Missouri\u2010Kansas City School of Medicine  Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0198-7703","authenticated-orcid":false,"given":"Rohit","family":"Kohli","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition Children's Hospital Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1482-1128","authenticated-orcid":false,"given":"Steven","family":"Lobritto","sequence":"additional","affiliation":[{"name":"Columbia University Medical Center, Morgan Stanley Children's Hospital of New York  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0327-1378","authenticated-orcid":false,"given":"Anna","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6979-8987","authenticated-orcid":false,"given":"James","family":"Squires","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-9684","authenticated-orcid":false,"given":"Emily","family":"Perito","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13528"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.01.030"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000933"},{"issue":"9","key":"e_1_2_9_5_1","article-title":"Defining the Society for Pediatric Liver Transplantation (SPLIT) Research Agenda: A Delphi Consensus Project","volume":"10","author":"Wadhwani S. 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