18 February 2022 : Original article
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 Shimada1ADEF*, Toshihiro Kitajima1BCE, Yukiko Suzuki1BD, Yasutaka Kuno1BD, Tayseer Shamaa1BC, Tommy Ivanics
1BCE, Kelly Collins1DE, Michael Rizzari1BD, Atsushi Yoshida1BD, Marwan Abouljoud1BD, Dilip Moonka2BD, Shunji Nagai1ACE
DOI: 10.12659/AOT.934850
Ann Transplant 2022; 27:e934850
Table 3 Transplanted patient characteristics according to the final transplant type in patients who were initially listed for simultaneous liver-kidney transplantation.
| n (%) | SLKn=1956 (95.3) | LTAn=95 (4.7) | P value | |
|---|---|---|---|---|
| Recipient age (year), median [IQR] | 59.0 [51.0, 64.0] | 59.0 [50.0, 62.0] | 0.33 | |
| Recipient age group (year) (%) | <50 | 397 (20.3) | 23 (24.2) | 0.33 |
| 50–59 | 672 (34.4) | 26 (27.4) | ||
| 60 or older | 887 (45.3) | 46 (48.4) | ||
| Recipient gender (%) | Male | 1201 (61.4) | 51 (53.7) | 0.16 |
| Recipient ethnicity (%) | White | 1271 (65.0) | 59 (62.1) | 0.04 |
| Black | 265 (13.5) | 6 (6.3) | ||
| Hispanic | 321 (16.4) | 24 (25.3) | ||
| Others | 99 (5.1) | 6 (6.3) | ||
| Recipient BMI, median [IQR] | 26.9 [23.4, 31.7] | 26.9 [23.9, 31.2] | 0.86 | |
| Moderate/severe ascites at LT (%) | 963 (49.3) | 48 (50.5) | 0.89 | |
| Dialysis at LT(%) | 1392 (71.2) | 56 (58.9) | 0.01 | |
| Grade 3/4 encephalopathy at LT(%) | 291 (14.9) | 17 (17.9) | 0.51 | |
| Mechanically ventilated at LT(%) | 327 (16.7) | 26 (27.4) | 0.01 | |
| MELD score at LT, median [IQR] | 30.0 [24.0, 36.0] | 34.0 [27.0, 39.5] | 0.003 | |
| MELD score group (%) | 6–29 | 950 (48.5) | 29 (30.5) | 0.001 |
| 30–34 | 387 (19.8) | 21 (22.1) | ||
| 35+ | 619 (31.7) | 45 (47.4) | ||
| Portal vein thrombosis at LT (%) | 224 (11.5) | 16 (16.8) | 0.15 | |
| Waiting time (day), median [IQR] | 43.0 [12.0, 136.0] | 27.0 [9.5, 87.0] | 0.03 | |
| eGFR at LT (ml/min), median [IQR] | 17.2 [11.2, 27.4] | 31.1 [15.3, 53.9] | <0.001 | |
| Serum creatinine at LT (mg/dL), median [IQR] | 3.4 [2.2, 4.9] | 2.0 [1.2, 3.5] | <0.001 | |
| Serum total bilirubin at LT (mg/dL), median [IQR] | 3.0 [1.1, 8.5] | 6.5 [2.4, 17.5] | <0.001 | |
| PT-INR at LT, median [IQR] | 1.6 [1.2, 2.1] | 1.9 [1.5, 2.5] | <0.001 | |
| Serum sodium at LT (mEq/L), median [IQR] | 136.0 [133.0, 139.0] | 136.0 [134.0, 138.0] | 0.84 | |
| Serum sodium group (mEq/L) (%) | <135 | 710 (36.3) | 25 (26.3) | 0.08 |
| 135–144 | 1202 (61.5) | 66 (69.5) | ||
| 145 or higher | 44 (2.2) | 4 (4.2) | ||
| Donor age (year), median [IQR] | 33.0 [24.0, 45.0] | 36.0 [26.5, 52.5] | 0.03 | |
| Donor age group (year) (%) | <40 | 1278 (65.3) | 55 (57.9) | <0.001 |
| 40–59 | 617 (31.5) | 27 (28.4) | ||
| 60 or older | 61 (3.1) | 13 (13.7) | ||
| Donor gender (%) | Male | 1207 (61.7) | 54 (56.8) | 0.39 |
| Donor BMI, median [IQR] | 26.9 [23.2, 31.4] | 26.7 [22.4, 31.6] | 0.38 | |
| Donor ethnicity (%) | White | 1283 (65.6) | 55 (57.9) | 0.32 |
| Black | 313 (16.0) | 15 (15.8) | ||
| Hispanic | 278 (14.2) | 18 (18.9) | ||
| Others | 82 (4.2) | 7 (7.4) | ||
| Cold ischemia time (hr), median [IQR] | 5.7 [4.6, 7.2] | 6.4 [4.7, 7.5] | 0.07 | |
| Donation after circulatory death (%) | 99 (5.1) | 5 (5.3) | 1.00 | |
| Share type (%) | Local | 1280 (65.4) | 52 (54.7) | 0.03 |
| Regional | 627 (32.1) | 42 (44.2) | ||
| National | 49 (2.5) | 1 (1.1) | ||
| 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; LT – liver transplant; LTA – liver transplant alone; MELD – model for end-stage liver disease; PT-INR – prothrombin time-international normalized ratio; SLK – simultaneous liver-kidney transplantation. | ||||