Exploring Disease-Specific Waitlist Dynamics in Simultaneous Liver-Kidney Transplantation
Recommended Citation
Oki R, Rajendran L, Kerby E, Mohamed A, Nassar A, Al-Kurd A, Kim D, Yoshida A, Abouljoud M, Nagai S. Exploring Disease-Specific Waitlist Dynamics in Simultaneous Liver-Kidney Transplantation. Am J Transplant 2025; 25(8):S276.
Document Type
Conference Proceeding
Publication Date
8-1-2025
Publication Title
Am J Transplant
Abstract
Purpose: Model for End-Stage Liver Disease (MELD) score system has been used to determine liver transplant (LT) waitlist ranking. While LT candidates have variety of primary liver diseases, the score systems have been used regardless of their disease etiology. In fact, our group previously reported that waitlist outcomes differed between those with major liver diseases in LT alone candidates. We hypothesized that waitlist outcomes varied depending on the etiology of liver disease in those who need simultaneous liver-kidney transplant (SLKT). We assessed the difference in in waitlist outcomes among major liver disease groups in SLKT candidates. Methods: Adult listed for SLKT from 2017-2023 were evaluated using the United Network for Organ Sharing database. Waitlist outcomes were compared between the five-disease groups, including alcohol-related liver disease (ALD), Metabolic dysfunction-Associated Steatohepatitis (MASH), hepatitis C virus infection (HCV), biliary diseases, and others. Waitlist outcomes including mortality or SLKT were assessed using Fine-Gray proportional hazard regression for competing events. Results: In total, 9,089 adult candidates for SLKT were enrolled.There were no significant differences in 90-day waitlist mortality and 90-day transplant rate among 5 etiologies adjusted with initial age, ascites, BMI, hemodialysis, MELD-Na-score and race. (Fig.1) When patients were categorized by initial MELD score (6-20, 21-29, and ≥30), biliary disease demonstrated better 90-day mortality compared to ALD in the lower MELD score group (p<0.001). In contrast, MASH had significantly worse 1-year waitlist mortality compared to ALD. ( HR1.36, 95%CI 1.15-1.59, p<0.001, Fig. 2) There were no difference in 1-year transplant rate. (Fig. 2) MASH demonstrated significantly worse 1-year mortality compared to ALD in the lower and middle MELD score groups (p=0.005, p=0.003) but showed no significant difference in the higher score group (p=0.390). Conclusions: There were significant differences in waitlist outcomes according to the liver etiologies in SLKT. Patients with MASH often had chronic metabolic diseases, which may include chronic kidney failure, which may be attributable to the findings of this study. MELD score systems failed to stratify patients’ medical urgency. [Formula presented] [Formula presented] CITATION INFORMATION: Oki R., Rajendran L., Kerby E., Mohamed A., Nassar A., Al-Kurd A., Kim D., Yoshida A., Abouljoud M., Nagai S. Exploring Disease-Specific Waitlist Dynamics in Simultaneous Liver-Kidney Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: R. Oki: None.
Volume
25
Issue
8
First Page
S276
