Exception Policy Change Increased the Simultaneous Kidney-liver Transplant Probability of Polycystic Disease in the Centers With High Median MELD at Transplantation

Authors

Katsunori Miyake, Henry Ford HealthFollow
Dean Y. Kim, Henry Ford HealthFollow
Lucy C. Chau, Henry Ford HealthFollow
Sheri Trudeau, Henry Ford HealthFollow
Toshihiro Kitajima, Henry Ford HealthFollow
Niluka Wickramaratne, Henry Ford HealthFollow
Shingo Shimada, Henry Ford HealthFollow
Ahmed Nassar, Henry Ford HealthFollow
Atsushi Yoshida, Henry Ford HealthFollow
Marwan S. Abouljoud, Henry Ford HealthFollow
Shunji Nagai, Henry Ford HealthFollow

Recommended Citation

Miyake K, Kim DY, Chau LC, Trudeau S, Kitajima T, Wickramaratne N, Shimada S, Nassar A, Yoshida A, Abouljoud MS, and Nagai S. Exception Policy Change Increased the Simultaneous Kidney-liver Transplant Probability of Polycystic Disease in the Centers With High Median MELD at Transplantation. Transplantation 2024.

Document Type

Article

Publication Date

3-29-2024

Publication Title

Transplantation

Abstract

BACKGROUND: In 2019, Organ Procurement and Transplantation Network/United Network for Organ Sharing changed the exception policy for liver allocation to the median model for end-stage liver disease at transplantation (MMaT). This study evaluated the effects of this change on-waitlist outcomes of simultaneous liver-kidney transplantation (SLKT) for patients with polycystic liver-kidney disease (PLKD).

METHODS: Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing registry, 317 patients with PLKD listed for SLKT between January 2016 and December 2021 were evaluated. Waitlist outcomes were compared between prepolicy (Era 1) and postpolicy (Era 2) eras.

RESULTS: One-year transplant probability was significantly higher in Era 2 than in Era 1 (55.7% versus 37.9%; P = 0.001), and the positive effect on transplant probability of Era 2 was significant after risk adjustment (adjusted hazard ratio, 1.76; 95% confidence interval, 1.22-2.54; P = 0.002 [ref. Era 1]), whereas waitlist mortality was comparable. Transplant centers were separated into the high and low MMaT groups with a score of 29 (median MMaT) and transplant probability in each group between eras was compared. In the high MMaT transplant centers, the 1-y transplant probability was significantly higher in Era 2 (27.5% versus 52.4%; P = 0.003). The positive effect remained significant in the high MMaT center group (adjusted hazard ratio, 2.79; 95% confidence interval, 1.43-5.46; P = 0.003 [ref. Era 1]) but not in the low MMaT center group. Although there was a difference between center groups in Era 1 (P = 0.006), it became comparable in Era 2 (P = 0.54).

CONCLUSIONS: The new policy increased 1-y SLKT probability in patients with PKLD and successfully reduced the disparities based on center location.

PubMed ID

38548699

ePublication

ePub ahead of print