Rachel Smith

Although New York City (NYC) is a hotspot for hepatitis delta virus (HDV) in the United States (US), the epidemiology of HDV remains poorly understood. We aimed to determine HDV testing and positivity rates, calculate prevalence of liver disease progression by HDV status, and assess the association between HDV and community resources. We utilized the INSIGHT database, which contains data from the five major NYC health systems, to identify adults with laboratory and/or diagnosis code evidence of hepatitis B virus (HBV) from 2010-2023. HDV positivity included HDV RNA ≥ 20 IU/mL and/or positive results for HDV Ab, RNA, and Ag. Prevalence of liver-related complications was calculated. Community deprivation index was used to evaluate socioeconomic disparities by HDV testing and positivity status. Here we show that among 106,210 patients with HBV, 5,388 (5.1%) have received HDV testing; 294 (5.5%) are HDV + . HDV-tested individuals are more likely to be older and Asian, receive comprehensive HBV care, and have more community resources. HDV+ individuals are more likely to be female, White, and have higher prevalence of liver disease progression. HDV is undertested and under-detected, even in a high-prevalence US region. Early linkage to treatment is essential given high rates of liver disease progression.

Transition of care from pediatric to adult providers occurs during a time of increased risk, especially in the liver transplant population where close follow‐up and adherence to immunologic therapies are critical to patient and graft survival. While there is a substantial body of literature supporting the need for improved transition from pediatric to adult care, concrete steps on how to implement a clinic and partner with adult colleagues are lacking. This article aims to provide a flexible pathway for transition clinics that can be tailored to an institution's unique needs while also advocating for system‐wide change to better support transitions in care, specifically through the lens of the United States health care system.

Background: The Society of Pediatric Liver Transplantation (SPLIT) has undergone tremendous growth with > 45 sites contributing data focusing on improving outcomes in pediatric liver transplantation (LT). We report and compare outcomes from the SPLIT Registry. Methods: Patients < 18 years with first‐time LT only enrolled into the SPLIT Registry between 2011 and 2023 were included. Data was stratified into eras from the last published registry update (era 1: 2011–2018, era 2: 2018–2023). Results: Three thousand five hundred four participants from 47 centers were included (era 1: n = 2159; era 2: n = 1345). Age distribution differed with more children < 1 year. of age at LT in era 2 (era 1: 29% vs. era 2: 33%, p = 0.01). Indications for LT were similar, with biliary atresia (38.8%) and metabolic disease (16.0%) being most common. Exception point use was higher in era 2 (era 1: 45% vs. era 2: 56%, p < 0.001). No difference in graft type (deceased: 81% era 1 vs. 78% era 2, p = 0.78), patient survival at 90 days (era 1: 98.7% vs. era 2: 98.3%), 1 year (era 1: 97.2 vs. era 2: 96.8%), or 3 years (era 1: 95.3% vs. era 2: 95.2%) was noted. Rate of hepatic artery thrombosis was lower in era 2 (era 1: 7% vs. era 2: 5%, p = 0.02). Conclusions: Trends in pediatric LT within SPLIT note similar LT indications and graft type, higher utilization of exception points, and lower HAT rates despite transplanting more children < 10 kg. This data underscores the evolution of pediatric LT toward higher survivability and overall patient outcomes.