Giuseppe Cullaro1, Ryutaro Hirose2, Jennifer C Lai1. 1. Department of Medicine, University of California, San Francisco, CA. 2. Division of Transplant Surgery, University of California, San Francisco, CA.
Abstract
BACKGROUND: Previous simultaneous liver-kidney (SLK) transplant allocation was based on serum creatinine, a metric that disadvantaged women relative to men. A recent SLK transplant policy change uses estimated glomerular filtration rate (eGFR), which accounts for sex-based differences in creatinine. METHODS: To understand the impact of this new policy, we analyzed nonstatus 1 adults listed for liver transplantation (LT) from May 2007 to July 2014, excluding those with exceptions. We defined patients who met the new SLK policy as having an eGFR <60 mL/min for 90 days, with a final eGFR <30 mL/min. RESULTS: Of 40979 candidates, 1683 would have met only the new criteria (N-SLK), 2452 would have met only the old criteria (O-SLK), and 1878 would have met both criteria (B-SLK). Compared to those in the B-SLK or O-SLK groups, those in the N-SLK group were significantly more likely to be female (52% versus 36% versus 39%, P < 0.001). Cox-regression analysis demonstrated that in adjusted analysis those in the N-SLK group were significantly less likely to die postliver transplant (hazard ratio [HR], 0.0; P < 0.001). Further, in Cox regression subgroup analyses, both in women (HR 0.04; P < 0.001) and in men (HR, 0.02, P < 0.001) those in the N-SLK group who underwent liver transplant were significantly less likely to die postliver transplant, even after adjustment for confounders. CONCLUSIONS: We anticipate that implementation of the new SLK policy will increase the proportion of women and decrease the proportion of men who are listed for SLK but may not improve posttransplant survival. Our data highlight the need for monitoring of SLK outcomes after implementation of the new policy.
BACKGROUND: Previous simultaneous liver-kidney (SLK) transplant allocation was based on serum creatinine, a metric that disadvantaged women relative to men. A recent SLK transplant policy change uses estimated glomerular filtration rate (eGFR), which accounts for sex-based differences in creatinine. METHODS: To understand the impact of this new policy, we analyzed nonstatus 1 adults listed for liver transplantation (LT) from May 2007 to July 2014, excluding those with exceptions. We defined patients who met the new SLK policy as having an eGFR <60 mL/min for 90 days, with a final eGFR <30 mL/min. RESULTS: Of 40979 candidates, 1683 would have met only the new criteria (N-SLK), 2452 would have met only the old criteria (O-SLK), and 1878 would have met both criteria (B-SLK). Compared to those in the B-SLK or O-SLK groups, those in the N-SLK group were significantly more likely to be female (52% versus 36% versus 39%, P < 0.001). Cox-regression analysis demonstrated that in adjusted analysis those in the N-SLK group were significantly less likely to die postliver transplant (hazard ratio [HR], 0.0; P < 0.001). Further, in Cox regression subgroup analyses, both in women (HR 0.04; P < 0.001) and in men (HR, 0.02, P < 0.001) those in the N-SLK group who underwent liver transplant were significantly less likely to die postliver transplant, even after adjustment for confounders. CONCLUSIONS: We anticipate that implementation of the new SLK policy will increase the proportion of women and decrease the proportion of men who are listed for SLK but may not improve posttransplant survival. Our data highlight the need for monitoring of SLK outcomes after implementation of the new policy.
Authors: E Cholongitas; L Marelli; A Kerry; D W Goodier; D Nair; M Thomas; D Patch; A K Burroughs Journal: Am J Transplant Date: 2007-01-11 Impact factor: 8.086
Authors: M K Nadim; R S Sung; C L Davis; K A Andreoni; S W Biggins; G M Danovitch; S Feng; J J Friedewald; J C Hong; J A Kellum; W R Kim; J R Lake; L B Melton; E A Pomfret; S Saab; Y S Genyk Journal: Am J Transplant Date: 2012-07-23 Impact factor: 8.086
Authors: Robert P Myers; Abdel Aziz M Shaheen; Alexander I Aspinall; Robert R Quinn; Kelly W Burak Journal: J Hepatol Date: 2010-09-19 Impact factor: 25.083
Authors: W Ray Kim; Scott W Biggins; Walter K Kremers; Russell H Wiesner; Patrick S Kamath; Joanne T Benson; Erick Edwards; Terry M Therneau Journal: N Engl J Med Date: 2008-09-04 Impact factor: 91.245
Authors: Jayme E Locke; Daniel S Warren; Andrew L Singer; Dorry L Segev; Christopher E Simpkins; Warren R Maley; Robert A Montgomery; Gabriel Danovitch; Andrew M Cameron Journal: Transplantation Date: 2008-04-15 Impact factor: 4.939
Authors: Giuseppe Cullaro; Pratima Sharma; Jennifer Jo; Jasmine Rassiwala; Lisa B VanWagner; Randi Wong; Jennifer C Lai; John Magee; Aaron Schluger; Pranab Barman; Yuval A Patel; Kara Walter; Scott W Biggins; Elizabeth C Verna Journal: Liver Transpl Date: 2021-08-20 Impact factor: 5.799
Authors: Mariya L Samoylova; Kara Wegermann; Brian I Shaw; Samuel J Kesseli; Sandra Au; Christine Park; Samantha E Halpern; Scott Sanoff; Andrew S Barbas; Yuval A Patel; Debra L Sudan; Carl Berg; Lisa M McElroy Journal: Liver Transpl Date: 2021-07-14 Impact factor: 6.112
Authors: David S Goldberg; Rodrigo M Vianna; Eric Fleming Martin; Paul Martin; Leopoldo Ramon Arosemena Benitez; Christopher Blackburn O'Brien; Kalyan R Bhamidimarri Journal: Transplantation Date: 2020-12 Impact factor: 4.939
Authors: Giuseppe Cullaro; Elizabeth C Verna; Jean C Emond; Babak J Orandi; Sumit Mohan; Jennifer C Lai Journal: Transplantation Date: 2021-04-01 Impact factor: 5.385