Baseline and Center-Level Variation in Simultaneous Liver-Kidney Listing in the United States. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Luo, Xun; Massie, Allan B.; Haugen, Christine E.; Choudhury, Rashikh; Ruck, Jessica M.; Shaffer, Ashton A.; Zhou, Sheng; Segev, Dorry L.; Garonzik-Wang, Jacqueline M.
• Is Part Of: Transplantation. Volume 102:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001984
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: The Organ Procurement and Transplantation Network has implemented medical criteria to determine which candidates are most appropriate for simultaneous liver-kidney (SLK) transplantation in comparison to liver-alone transplantation. We investigated prepolicy center-level variation among SLK listing practice, in light of such criteria. Methods: We identified 4736 SLK-eligible candidates after Share-35 in the United States. We calculated the proportion of candidates at each center who were listed for SLK transplantation within 6 months of eligibility. Multilevel logistic regression and parametric survival model was used to estimate the center-specific probability of SLK listing, adjusting for patient and center-level characteristics. Results: Among 4736 SLK-eligible candidates, 64.8% were listed for SLK within 6 months of eligibility. However, the percentage of SLK listing ranged from 0% to 100% across centers. African American race, male sex, transplant history, diabetes, and hypertension were associated with a higher likelihood of SLK listing. Conversely, older age was associated with a lower likelihood of SLK listing. After adjusting for candidate characteristics, the percentage of SLK listing still ranged from 3.8% to 80.2% across centers; this wide variation persisted even after further adjusting for center-level characteristics. Conclusions: There was significant prepolicy center-level variation in SLK listing for SLK-eligible candidates. Implementation of standardized SLK listing practices may reduce center-level variation and equalize access for SLK candidates across the United States. Abstract : The authors draw attention to the significant center-level variation in the listing practice for patients needing simultaneous liver and kidney transplantation. It is anticipated that the new OPTN listing standards will improve this situation.