Baseline and center-level variation in simultaneous liver-kidney listing in the United States

Xun Luo, Allan B Massie, Christine E. Haugen, Rashikh Choudhury, Jessica M. Ruck, Ashton A. Shaffer, Sheng Zhou, Dorry Segev, Jacqueline Garonzik

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)609-615
Number of pages7
JournalTransplantation
Volume102
Issue number4
DOIs
StatePublished - Apr 1 2018

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Kidney
Liver
Liver Transplantation
Kidney Transplantation
Tissue and Organ Procurement
Organ Transplantation
African Americans
Logistic Models
History
Hypertension
Transplants
Survival

ASJC Scopus subject areas

  • Transplantation

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Baseline and center-level variation in simultaneous liver-kidney listing in the United States. / Luo, Xun; Massie, Allan B; Haugen, Christine E.; Choudhury, Rashikh; Ruck, Jessica M.; Shaffer, Ashton A.; Zhou, Sheng; Segev, Dorry; Garonzik, Jacqueline.

In: Transplantation, Vol. 102, No. 4, 01.04.2018, p. 609-615.

Research output: Contribution to journalArticle

Luo, Xun ; Massie, Allan B ; Haugen, Christine E. ; Choudhury, Rashikh ; Ruck, Jessica M. ; Shaffer, Ashton A. ; Zhou, Sheng ; Segev, Dorry ; Garonzik, Jacqueline. / Baseline and center-level variation in simultaneous liver-kidney listing in the United States. In: Transplantation. 2018 ; Vol. 102, No. 4. pp. 609-615.
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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.",
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AU - Ruck, Jessica M.

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N2 - 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.

AB - 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.

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