Liver waitlist registrants with kidney disease may receive simultaneous liver-kidney (SLK) transplant, or liver-only (LT). Patient characteristics associated with SLK, and center-level variation in SLK utilization, have not previously been described.

METHODS: Using SRTR data 2002-2013, we studied 17,869 LT and SLK recipients with eGFR<60ml/min at transplant or a history of dialysis, using multilevel modified Poisson regression to model chance of SLK, accounting for center-level variation. Akaike information criterion (AIC) was used in model selection.

RESULTS: Overall, 24.4% of eligible patients received SLK. Male gender, lower eGFR, history of hypertension, diabetes, and no prior kidney transplant were associated with increased chance of SLK (Table 1). Higher MELD was associated with less chance of SLK for MELD>30.

The chance of SLK varied significantly across centers, after accounting for patient casemix (Figure 1).

Even though race was not associated with chance of SLK overall, SLK RR of African-American (AA) had center variation (Figure 2). AAs were statistically significantly more likely than non-AAs to receive SLK at 25 centers, and less likely to receive SLK at 6 centers.

CONCLUSIONS: Among liver patients with decreased eGFR or prior dialysis, male gender, lower eGFR, hypertension, diabetes, and no prior kidney transplant were associated with SLK utilization. Centers differed widely in utilization of SLK, independent of casemix. Center variation also existed in race disparity.

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