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 5 Transplanted patient characteristics at time of simultaneous liver-kidney transplantation between the eras.
| n (%) | Before the 2017 policyn=1311 (67.0) | After the 2017 policyn=645 (33.0) | P value | |
|---|---|---|---|---|
| Recipient age (year), median [IQR] | 59.0 [51.0, 64.0] | 52.0 [52.0, 62.0] | 0.21 | |
| Recipient age group (year) (%) | 270 (20.6) | 127 (19.7) | 0.89 | |
| 50–59 | 448 (34.2) | 224 (34.7) | ||
| 60 or older | 593 (45.2) | 294 (45.6) | ||
| Recipient gender (%) | Male | 821 (62.6) | 380 (58.9) | 0.12 |
| Recipient ethnicity (%) | White | 853 (65.1) | 418 (64.8) | 0.005 |
| Black | 187 (14.3) | 78 (12.1) | ||
| Hispanic | 216 (16.5) | 105 (16.3) | ||
| Others | 55 (4.2) | 44 (6.9) | ||
| Recipient BMI, median [IQR] | 26.9 [23.4, 31.8] | 27.0 [23.7, 31.7] | 0.77 | |
| Moderate/severe ascites at SLK (%) | 645 (49.2) | 318 (49.3) | 1.00 | |
| Dialysis at SLK(%) | 923 (70.5) | 469 (72.8) | 0.30 | |
| Grade 3/4 encephalopathy at SLK(%) | 202 (15.4) | 89 (13.8) | 0.37 | |
| Mechanically ventilated at SLK(%) | 213 (16.2) | 114 (17.7) | 0.46 | |
| MELD score at SLK | 30.0 [24.0, 36.8] | 30.0 [23.0, 35.0] | 0.17 | |
| MELD score group (%) | 6–29 | 638 (48.7) | 312 (48.4) | 0.06 |
| 30–34 | 242 (18.5) | 145 (22.5) | ||
| 35+ | 431 (32.9) | 188 (29.1) | ||
| Portal vein thrombosis at SLK (%) | 146 (11.1) | 78 (12.1) | 0.58 | |
| Waiting time (day) | 41.0 [12.0, 150.5] | 46.0 [12.0, 121.0] | 0.24 | |
| eGFR at SLK (ml/min) | 17.8 [11.5, 28.2] | 16.3 [11.0, 26.0] | 0.04 | |
| Serum creatinine at SLK (mg/dL), median [IQR] | 3.4 [2.3, 4.8] | 3.5 [2.3, 5.1] | 0.16 | |
| Serum total bilirubin at SLK (mg/dL), median [IQR] | 3.2 [1.2, 9.9] | 2.6 [1.0, 6.3] | 0.003 | |
| PT-INR at SLK, median [IQR] | 1.6 [1.2, 2.2] | 1.6 [1.2, 2.1] | 0.25 | |
| Serum sodium at SLK (mEq/L), median [IQR] | 136.0 [133.3, 139.0] | 136.0 [133.0, 139.0] | 0.005 | |
| Serum sodium group (mEq/L) (%) | 450 (34.3) | 260 (40.3) | 0.02 | |
| 135–144 | 828 (63.2) | 374 (58.0) | ||
| 145 or higher | 33 (2.5) | 11 (1.7) | ||
| Donor age (year), median [IQR] | 33.0 [24.0, 45.0] | 34.0 [26.0, 45.0] | 0.25 | |
| Donor age group (year) (%) | 854 (65.1) | 424 (65.7) | 0.68 | |
| 40–59 | 413 (31.5) | 204 (31.6) | ||
| 60 or older | 44 (3.4) | 17 (2.6) | ||
| Donor gender (%) | Male | 809 (61.7) | 398 (61.7) | 1.00 |
| Donor BMI, median [IQR] | 26.0 [22.9, 30.1] | 26.6 [23.3, 30.5] | 0.06 | |
| Donor ethnicity (%) | White | 871 (66.4) | 412 (63.9) | 0.33 |
| Black | 202 (15.4) | 111 (17.2) | ||
| Hispanic | 187 (14.3) | 91 (14.1) | ||
| Others | 51 (3.9) | 31 (4.8) | ||
| Cold ischemia time (hr), median [IQR] | 5.9 [4.7, 7.3] | 5.6 [4.5, 7.0] | 0.008 | |
| Donation after circulatory death (%) | 65 (5.0) | 34 (5.3) | 0.85 | |
| Share type (%) | Local | 880 (67.1) | 400 (62.0) | 0.05 |
| Regional | 397 (30.3) | 230 (35.7) | ||
| National | 34 (2.6) | 15 (2.3) | ||
| 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. | ||||