Effects of Longitudinal Profiles of Pediatric End-stage Liver Disease (PELD) Scores on Post-transplant Survival

Liver transplant has long been the ultimate treatment for patients with end-stage liver disease. For pediatric patients under 12 years old, the Pediatric End-Stage Liver Disease (PELD) scoring system has been developed and implemented for almost 10 years as an estimation of 90-day mortality pre-transplantation. PELD score has been used as an appropriate tool to discriminate patients when allocating organs, yet as a potential predictor of post-transplant graft failure, its effect has been somewhat inconsistent. In previous studies, researchers tended to use single measured PELD score at the time of listing or at transplant in predicting graft survival, while in clinical practice PELD scores are often calculated multiple times between listing and transplant to monitor patients’ disease status. To make the most use of the information of the repeated PELD measures, we propose to employ latent group-based trajectory models to explore the underlying distinct patterns of the PELD scores and then integrate such longitudinal profiles into survival analysis to examine its effects as a predictor of graft survival.\ud \ud Public health significance: This study will provide both the medical and public health communities with important information that will facilitate their evidence-based practice concerning pediatric patients in need of liver transplant. Researchers will get to see the big picture regarding this health issue since national data have been used to derive the results. They will have a better idea of patients’ disease status and prognosis and will be able to make treatment or intervention decisions with more confidence