Previous simultaneous liver-kidney (SLK) transplant allocation was based on serum creatinine, a metric that disadvantaged women relative to men. A recent SLK transplant policy change uses estimated glomerular filtration rate (eGFR), which accounts for sex-based differences in creatinine.
To understand the impact of this new policy, we analyzed nonstatus 1 adults listed for liver transplantation (LT) from May 2007 to July 2014, excluding those with exceptions. We defined patients who met the new SLK policy as having an eGFR <60 mL/min for 90 days, with a final eGFR <30 mL/min.
Of 40979 candidates, 1683 would have met only the new criteria (N-SLK), 2452 would have met only the old criteria (O-SLK), and 1878 would have met both criteria (B-SLK). Compared to those in the B-SLK or O-SLK groups, those in the N-SLK group were significantly more likely to be female (52% versus 36% versus 39%, P < 0.001). Cox-regression analysis demonstrated that in adjusted analysis those in the N-SLK group were significantly less likely to die postliver transplant (hazard ratio [HR], 0.0; P < 0.001). Further, in Cox regression subgroup analyses, both in women (HR 0.04; P < 0.001) and in men (HR, 0.02, P < 0.001) those in the N-SLK group who underwent liver transplant were significantly less likely to die postliver transplant, even after adjustment for confounders.
We anticipate that implementation of the new SLK policy will increase the proportion of women and decrease the proportion of men who are listed for SLK but may not improve posttransplant survival. Our data highlight the need for monitoring of SLK outcomes after implementation of the new policy.
1 Department of Medicine, University of California, San Francisco, CA.
2 Division of Transplant Surgery, University of California, San Francisco, CA.
Received 3 April 2018. Revision received 30 July 2018.
Accepted 1 August 2018.
This study was funded by K23AG048337 (Paul B. Beeson Career Development Award in Aging Research; Lai) and by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (UCSF Liver Center P30 DK026743, T32 DK060414; Cullaro), both of which played no role in the analysis of the data or the preparation of this manuscript.
The authors declare no conflicts of interest.
G.C. participated in research design, writing the article, performance of the research, and data analysis. R.H. participated in research design, writing the article, and data analysis. J.C.L. participated in research design, writing the manuscript, performance of the research, and data analysis.
Correspondence: Jennifer C. Lai, MD, 505 Parnassus Ave, San Francisco, CA 94117. (firstname.lastname@example.org).