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

ABSTRACT Background The OPTN has implemented medical criteria to determine which candidates are most appropriate for simultaneous liver-kidney transplantation (SLK) in comparison to liver-alone transplantation. We investigated prepolicy center-level variation among SLK-listing practice, in light of such criteria. Methods We identified 4,736 SLK-eligible candidates after Share-35 in the U.S. We calculated the proportion of candidates at each center who were listed for SLK within 6 months of eligibility. Multi-level 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 4,736 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 gender, prior 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 US. Contact Information: Jacqueline Garonzik-Wang, M.D., Ph.D., Department of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 771, Baltimore, MD 21205, 410-502-5198 (tel) 410-510-1514 (fax). jgaronz1@jhmi.edu Author Contributions: Xun Luo, Allan B. Massie, Dorry L. Segev, and Jacqueline M. Garonzik-Wang participated in research design. Xun Luo, Allan B. Massie, Dorry L. Segev, and Jacqueline M. Garonzik-Wang contributed to data analysis. Xun Luo, Allan B. Massie, Christine E. Haugen, Rashikh Choudhury, Jessica M. Ruck, Ashton A. Shaffer, Sheng Zhou, Dorry L. Segev, and Jacqueline M. Garonzik-Wang wrote the paper. Conflict of Interest Disclosures: The authors declare no conflicts of interest. Funding: 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), and F32AG053025 from the National Institute on Aging (NIA). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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