TY - JOUR
T1 - Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States
AU - Chang, Su Hsin
AU - Wang, Mei
AU - Liu, Xiaoyan
AU - Alhamad, Tarek
AU - Lentine, Krista L.
AU - Schnitzler, Mark A.
AU - Colditz, Graham A.
AU - Park, Yikyung
AU - Chapman, William C.
N1 - Funding Information:
1Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO. 2Department of Biostatistics, Boston University School of Public Health, Boston, MA. 3Division of Nephrology, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO. 4Center for Abdominal Transplantation, Saint Louis University, St Louis, MO. 5Section of Abdominal Transplantation, Department of Surgery, Washington University School of Medicine, St Louis, MO. The authors declare no conflicts of interest. This research was supported by the Foundation for Barnes-Jewish Hospital. S.-H.C. is supported by the Agency for Healthcare Research and Quality (grant K01 HS022330) and the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (grant R21 DK110530).
Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background. Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. However, whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival remains understudied. Methods. A retrospective cohort of patients aged ≥18 years with renal dysfunction on the liver transplant (LT) waiting list was obtained from Organ Procurement and Transplantation Network. Renal dysfunction was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 at listing for LT. Multilevel time-To-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT. Inverse probability of treatment weighted survival analyses were used to analyze posttransplant mortality outcomes. Results. For patients with renal dysfunction at listing for LT, not listed for simultaneous kidney transplant, non-Hispanic black (NHB) and Hispanic patients were more likely to receive SLKT than non-Hispanic white (NHW) patients (NHB: multivariable-Adjusted hazard ratio [aHR] 2.57; 95% confidence interval [CI], 1.42-4.65; Hispanic: AHR, 2.03; 95% CI, 1.14-3.60). For post-SLKT outcomes, compared to NHW patients, NHB patients had a lower mortality risk before 24 months (aHR, 0.80; 95% CI, 0.65-0.97) but had a higher mortality risk (aHR, 2.00; 95% CI, 1.59-2.55) afterward; in contrast, Hispanic patients had a lower overall mortality risk than NHW patients (aHR, 0.61; 95% CI, 0.51-0.74). Conclusions. In the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT. Future studies are warranted to examine whether these differences remain in the post-SLK allocation policy era.
AB - Background. Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. However, whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival remains understudied. Methods. A retrospective cohort of patients aged ≥18 years with renal dysfunction on the liver transplant (LT) waiting list was obtained from Organ Procurement and Transplantation Network. Renal dysfunction was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 at listing for LT. Multilevel time-To-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT. Inverse probability of treatment weighted survival analyses were used to analyze posttransplant mortality outcomes. Results. For patients with renal dysfunction at listing for LT, not listed for simultaneous kidney transplant, non-Hispanic black (NHB) and Hispanic patients were more likely to receive SLKT than non-Hispanic white (NHW) patients (NHB: multivariable-Adjusted hazard ratio [aHR] 2.57; 95% confidence interval [CI], 1.42-4.65; Hispanic: AHR, 2.03; 95% CI, 1.14-3.60). For post-SLKT outcomes, compared to NHW patients, NHB patients had a lower mortality risk before 24 months (aHR, 0.80; 95% CI, 0.65-0.97) but had a higher mortality risk (aHR, 2.00; 95% CI, 1.59-2.55) afterward; in contrast, Hispanic patients had a lower overall mortality risk than NHW patients (aHR, 0.61; 95% CI, 0.51-0.74). Conclusions. In the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT. Future studies are warranted to examine whether these differences remain in the post-SLK allocation policy era.
UR - http://www.scopus.com/inward/record.url?scp=85070633665&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000002574
DO - 10.1097/TP.0000000000002574
M3 - Article
C2 - 30720678
AN - SCOPUS:85070633665
SN - 0041-1337
VL - 103
SP - 1663
EP - 1674
JO - Transplantation
JF - Transplantation
IS - 8
ER -