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

ASJC Scopus subject areas

  • Transplantation

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