18 February 2022: Original Paper
Impact on Waitlist Outcomes from Changes in the Medical Eligibility of Candidates for Simultaneous Liver-Kidney Transplantation Following Implementation of the 2017 Organ Procurement and Transplantation Network/United Network for Organ Sharing Policy in the United States
Shingo Shimada 1ADEF , Toshihiro Kitajima 1BCE , Yukiko Suzuki 1BD , Yasutaka Kuno 1BD , Tayseer Shamaa 1BC , Tommy Ivanics 1BCE , Kelly Collins 1DE , Michael Rizzari 1BD , Atsushi Yoshida 1BD , Marwan Abouljoud 1BD , Dilip Moonka 2BD , Shunji Nagai 1ACE*DOI: 10.12659/AOT.934850
Ann Transplant 2022; 27:e934850
Table 1 Patient characteristics in simultaneous liver-kidney transplantation listings before and after the 2017 policy.
| n (%) | Group | Before the 2017 policyn=2975 (64.1) | After the 2017 policyn=1666 (35.9) | P value |
|---|---|---|---|---|
| The daily number of registered patients, [IQR] | 3.25 [0, 5] | 2.89 [0, 5] | 0.01 | |
| Age (year), median [IQR] | 59.0 [52.0, 64.0] | 59.0 [53.0, 64.0] | 0.10 | |
| Age group (year), n (%) | 553 (18.6) | 323 (19.4) | 0.08 | |
| 50–59 | 1052 (35.4) | 535 (32.1) | ||
| 60 or older | 1370 (46.0) | 808 (48.5) | ||
| Ethnicity, n (%) | White | 1807 (60.7) | 987 (59.2) | 0.009 |
| Black | 386 (13.0) | 216 (13.0) | ||
| Hispanic | 610 (20.5) | 345 (20.7) | ||
| Others | 172 (5.8) | 118 (7.1) | ||
| Gender, n (%) | Male | 1802 (60.6) | 949 (57.0) | 0.01 |
| Female | 1173 (39.4) | 717 (43.0) | ||
| BMI, median [IQR] | 27.6 [24.1, 32.3] | 27.7 [24.2, 32.4] | 0.67 | |
| eGFR (ml/min), median [IQR] | 19.3 [11.7, 32.4] | 17.5 [10.8, 29.1] | ||
| Serum creatinine (mg/dL), median [IQR] | 3.0 [1.9, 4.8] | 3.3 [2.1, 5.2] | ||
| Serum total bilirubin (mg/dL), median [IQR] | 1.7 [0.8, 4.2] | 1.5 [0.7, 3.4] | ||
| PT-INR, median [IQR] | 1.4 [1.1, 1.8] | 1.3 [1.1, 1.7] | ||
| Serum sodium (mEq/L), median [IQR] | 137.0 [134.0, 139.0] | 137.0 [134.0, 140.0] | 0.004 | |
| Serum sodium group (mEq/L), n (%) | 935 (31.4) | 482 (28.9) | 0.12 | |
| 135–144 | 1985 (66.7) | 1145 (68.7) | ||
| 145 or higher | 55 (1.8) | 39 (2.3) | ||
| Moderate/severe ascites, n (%) | 1217 (40.9) | 676 (40.6) | 0.82 | |
| Karnofsky score, n (%) | 10–30% | 983 (33.3) | 546 (33.2) | |
| 40–60% | 1207 (40.9) | 755 (45.8) | ||
| 70–100% | 759 (25.7) | 346 (21.0) | ||
| Dialysis requirement, n (%) | 1475 (49.6) | 865 (51.9) | 0.14 | |
| Grade 3/4 encephalopathy, n (%) | 275 (9.3) | 145 (8.7) | 0.57 | |
| Mechanically ventilated, n (%) | 208 (7.0) | 119 (7.2) | 0.007 | |
| Initial MELD (MELD-Na) score, median [IQR] | 23.0 [20.0, 30.0] | 23.0 [20.0, 30.0] | 0.91 | |
| MELD score group, n (%) | 6–29 | 2191 (73.6) | 1242 (74.5) | 0.06 |
| 30–34 | 354 (11.9) | 220 (13.2) | ||
| 35+ | 430 (14.5) | 204 (12.2) | ||
| Portal vein thrombosis, n (%) | 185 (6.2) | 98 (5.9) | 0.71 | |
| Data was summarized using the median with interquartile range (IQR) for continuous variables and using percentage for discrete variables. Continuous variables were analyzed using the Mann Whitney-U test and discrete variables were analyzed using a chi-square test. BMI – body mass index; eGFR – estimated glomerular filtration rate; MELD – model for end-stage liver disease; PT-INR – prothrombin time-international normalized ratio; SLK – simultaneous liver-kidney transplantation. | ||||