The OPTN has proposed medical eligibility criteria to determine which transplant candidates are appropriate for SLK vs liver-alone transplantation. We investigated center variation of SLK listing, in light of the criteria.

Methods: We used SRTR data to study 14,419 liver transplant candidates after Share-35, who met the SLK criteria. We calculated the proportion of candidates at each center who listed for SLK within 6 months of eligibility. Multi-level Poisson regression was used to estimate the center-specific probability of SLK listing, adjusting for characteristics.

Results: Among eligible patients, 25.6% were listed for SLK within 6-months. However, the proportion of SLK listing ranged from 0%-100% across centers (Figure 1). African American race (2.24x), male gender (1.37x), higher MELD (among MELD<25) (1.61x), prior transplant history (1.61x), diabetes (1.52x), and hypertension (1.71x) were associated with a greater chance of SLK listing. Conversely, older age (0.74x), higher MELD (among MELD≥25) (0.82x), and exception-status (0.56x) were associated with a less chance of SLK listing (Table). Even after adjustment, the probability ranged from 2.5%-99.9% across centers (Figure 2).

Conclusions: Due to the center variation in listing, SLK eligible candidates may be severely disadvantaged in access to SLK based on center listing practices.

CITATION INFORMATION: Luo X, Massie A, Garonzik-Wang J, Choudhury R, Shaffer A, Zhou S, Segev D. Current Practice and Center-Level Variation in Simultaneous Liver-Kidney Listing. Am J Transplant. 2017;17 (suppl 3).

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