Journal article
Differential Impact of the UNOS Simultaneous Liver-kidney Transplant Policy Change Among Patients With Sustained Acute Kidney Injury
Transplantation, Vol.108(3), pp.724-731
03/2024
DOI: 10.1097/TP.0000000000004774
PMID: 37677960
Abstract
Background. Simultaneous liver-kidney transplant (SLK) allocation policy in the United States was revised in August 2017, reducing access for liver transplant candidates with sustained acute kidney injury (sAKI) and potentially adversely impacting vulnerable populations whose true renal function is overestimated by commonly used estimation equations. Methods. We examined national transplant registry data containing information for all liver transplant recipients from June 2013 to December 2021 to assess the impact of this policy change using instrumental variable estimation based on date of listing. Results. Posttransplant survival was compared for propensity-matched patients with sAKI who were only eligible for liver transplant alone (LTA_post; n = 638) after the policy change but would have been SLK-eligible before August 2017, with similar patients who were previously able to receive an SLK (SLK; n = 319). Overall posttransplant patient survival was similar at 3 y (81% versus 80%; P = 0.9). However, receiving an SLK versus LTA increased survival among African Americans (87% versus 61% at 3 y; P = 0.029). A trend toward survival benefit from SLK versus LTA, especially later in the follow-up period, was observed in recipients ≥ age 60 (3-y survival: 84% versus 76%; P = 0.2) and women (86% versus 80%; P = 0.2). Conclusions. The 2017 United Network for Organ Sharing SLK Allocation Policy was associated with reduced survival of African Americans with end-stage liver disease and sAKI and, potentially, older patients and women. Our study suggested the use of race-neutral estimation of renal function would ameliorate racial disparities in the SLK arena; however, further studies are needed to reduce disparity in posttransplant outcomes among patients with liver and kidney failure.
Details
- Title: Subtitle
- Differential Impact of the UNOS Simultaneous Liver-kidney Transplant Policy Change Among Patients With Sustained Acute Kidney Injury
- Creators
- Tomohiro Tanaka - University of IowaKrista L. Lentine - Saint Louis University HospitalQianyi Shi - Iowa City VA Health Care SystemMark Vander Weg - University of IowaDavid A. Axelrod - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.108(3), pp.724-731
- DOI
- 10.1097/TP.0000000000004774
- PMID
- 37677960
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Language
- English
- Electronic publication date
- 09/06/2023
- Date published
- 03/2024
- Academic Unit
- Psychological and Brain Sciences; Gastroenterology and Hepatology; Surgery; Injury Prevention Research Center; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9984464481702771
Metrics
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