EXCEPTION POLICY CHANGE INCREASED THE SIMULTANEOUS KIDNEY-LIVER TRANSPLANT PROBABILITY IN PATIENTS WITH POLYCYSTIC DISEASE IN THE CENTERS WITH HIGH MEDIAN MELD AT TRANSPLANTATION

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: Polycystic liver kidney disease (PLKD) is a potential indication for simultaneous liver-kidney (SLK) transplantation. Because PLKD patients often have retained hepatic synthetic function and LT is indicated for symptoms related to the enlarged, they are often granted MELD exception points in the US liver allocation system. In 2019, Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) implemented a new exception policy of median Model for End-Stage Liver Disease at transplant minus 3 points (MMaT-3). The aim of this study is to evaluate possible impact of this policy change on waitlist outcome in PLKD patients listed for SLK. Methods: OPTN/UNOS database was queried for Adult PLKD patients listed for SLK from Jan. 1, 2016 to Dec. 31, 2021. Patients were divided into 2 groups (pre-MMaT- 3 policy era, post-MMaT- 3 policy era) according to the registration date. One-year SLK transplant probabilities were compared between eras using Fine-Gray models. As a subgroup analysis, transplant centers were divided into 2 groups (high MMaT>=30, low MMaT<30), and likelihood of 1-year SLK of PLKD patients were compared between eras in both groups separately. Results: The study cohort included 317 patients with PLKD with 190 in the pre-and 127 patients in the post-policy era. In the two eras, 99 (52.1%) and 53 (41.7%) patients received exception scores respectively, and there was no significant difference between their median laboratory MELD scores at registration (21.0 [17.0-22.0] and 21.0 [17.25-22.0]) and at transplantation(22.0[20.0-23.0] and 21.0[19.0-23.0], respectively). Patients in the post-policy era had a higher 1-year SLK transplant probability with a subdistribution hazard ratio of 1.8 (95% Cl: 1.26-2.63: p=0.001) compared to the pre-policy era. In the subgroup analysis, in the high MMaT group , SLK transplant probability in the post-policy era was significantly higher compared to that in the pre-policy era (p=0.001) but this was not observed in the low MMaT group (Figure). When comparing transplant probabilities between the MMaT groups in each era, the low MMaT group had significantly higher 1-year SLK probability in the pre-policy era (p=0.006), but this became comparable between low and high MMaT groups in the post-policy era (p=0.54). Conclusion: Our results suggest that the MMaT-3 policy is associated with an increased 1 year SLK probability in PKLD patients and reduced disparities in SLK access. (Figure Presented).

Volume

76

First Page

S492

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