A deeper dive into the impact of multiple-organ transplant policy on kidney transplant candidate prognoses

Schold, Jesse D.; Mohan, Sumit

doi:10.1111/ajt.16508

Cited by 1 publication

(1 citation statement)

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“…6 By contrast, 2022 now represents the most SLK transplants performed nationally. 20 The current results do indicate that kidneyafter-liver transplants increased over time (103 in 2021 compared with 51 in 2018), but still represent a small minority of liver-kidney transplants. Considering the relatively favorable outcomes for kidney-after-liver transplant, current findings combined with previous studies may suggest benefits for identifying more patients who could benefit from kidney-after-liver.…”

Section: Discussionmentioning

confidence: 54%

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver–Kidney, and Kidney-after-Liver Transplants

Schold,

Mohan,

Jackson

et al. 2023

CJASN

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Background The number of simultaneous liver-kidney transplants has significantly increased in the United States. There has also been an increase in kidney-after-liver transplants associated with 2017 policy revisions aimed to fairly allocate kidneys after livers. Simultaneous liver-kidney and kidney-after-liver candidates are prioritized in allocation policy for kidney offers ahead of kidney-alone candidates. Methods We compared kidney graft outcomes of kidney-alone transplant recipients to simultaneous liver-kidney and kidney-after-liver transplants using paired kidney models to mitigate differences among donor risk factors. We evaluated recipient characteristics between transplant types and calculated differential graft years using restricted mean survival estimates. Results We evaluated 3053 paired donors to kidney-alone and simultaneous liver-kidney recipients and 516 paired donors to kidney-alone and kidney-after-liver recipients from 8/2017-8/2022. Kidney-alone recipients were younger, more likely on dialysis and Black race. One and three-year post-transplant kidney graft survival for kidney-alone recipients was (94% and 86%) vs. simultaneous liver-kidney recipients(89% and 80%,respectively,p<0.001). One and three-year kidney graft survival for kidney-alone recipients was (94% and 84%) vs. kidney-after-liver recipients (93% and 87%,respectively,p=0.53). The additional kidney graft years for kidney-alone vs simultaneous liver-kidney transplants was 21 graft years/100 transplants(standard error=5.0) within four-years post-transplantation with no significant difference between kidney-after-liver and kidney-alone transplants. Conclusions Over a five-year period in the US, simultaneous liver-kidney transplantation was associated with significantly lower kidney graft survival compared to paired kidney-alone transplants. Most differences in graft survival between simultaneous liver-kidney and kidney-alone transplants occurred within the first-year post-transplantation. In contrast, kidney-after-liver transplants had comparable graft survival to paired kidney-alone transplants.

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Section: Discussionmentioning

confidence: 54%

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver–Kidney, and Kidney-after-Liver Transplants

Schold,

Mohan,

Jackson

et al. 2023

CJASN

Self Cite

View full text Add to dashboard Cite

show abstract

A deeper dive into the impact of multiple-organ transplant policy on kidney transplant candidate prognoses

Abstract: Multi‐organ transplantation exerts a complex impact on kidney transplant candidate outcomes but considerations of overall outcomes and equity may drive reconsideration of allocation policy. See page 2161 for an article from Westphal et al.

Cited by 1 publication

References 5 publications

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver–Kidney, and Kidney-after-Liver Transplants

Differential in Kidney Graft Years on the Basis of Solitary Kidney, Simultaneous Liver–Kidney, and Kidney-after-Liver Transplants

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