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Baseline and Center-Level Variation in Simultaneous Liver-Kidney Listing in the United States

Luo, Xun, MD, MPH1; Massie, Allan B., PhD, MHS1,2; Haugen, Christine E., MD1; Choudhury, Rashikh, MD1; Ruck, Jessica M., BS1; Shaffer, Ashton A., BA1,2; Zhou, Sheng, MD, MPH1; Segev, Dorry L., MD, PhD1,2; Garonzik-Wang, Jacqueline M., MD, PhD1

doi: 10.1097/TP.0000000000001984
Original Clinical Science—Liver

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.

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.

1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

2 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.

Received 30 March 2017. Revision received 5 October 2017.

Accepted 10 October 2017.

This work is supported by grants: K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 1R01DK111233-01 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), F30DK116658-01 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and F32AG053025 from the National Institute on Aging (NIA).

The authors declare no conflicts of interest.

X.L., A.B.M., D.L.S., and J.M.G.-W. participated in research design. X.L., A.B.M., D.L.S., and J.M.G.-W. contributed to the data analysis. X.L., A.B.M., C.E.H., R.C., J.M.R., A.A.S., S.Z., D.L.S., and J.M.G.-W. wrote the article.

Correspondence: Jacqueline Garonzik-Wang, MD, PhD, Department of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 771, Baltimore, MD 21205. (

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