Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Previous SLK allocation was based on serum creatinine(Cr), a metric that disadvantaged women(W) relative to men(M). A SLK policy change utilizes eGFR, which accounts for sex-based differences in Cr. We aimed to understand the impact of this new policy on liver transplant(LT) outcomes in W and M.
Methods: Included were non-Status 1 adults listed for LT from 5/07-7/14. Excluded were those with exceptions. We defined patients(pts) who met the new SLK policy as having an eGFR<60ml/min (by CKD-EPI) for 90d, with a final eGFR<35ml/min. Competing risks regression estimated the subhazard ratio (sHR) for sex with need for kidney transplant after LT (KALT) in those who met the new SLK policy but underwent LT alone (LTA). Cox regression associated LTA v. SLK with post-LT survival in W.
Results: Of 40,979 LT candidates, 4,330 were listed for SLK from '07-'14; 37% were W. 3,123 pts would have met new SLK criteria: 46% would have been W. Of the 3,123 pts who would have met new SLK criteria, 47%W v. 62%M were actually listed for SLK(p<0.01), despite clinically similar final eGFR(18v.17ml/min,p=0.01).
Of the same 3,123 pts who would have met new SLK criteria, 548 received LTA: 55% were W. Fewer W than M were subsequently listed for KALT(8v.13%,p=0.04). Median time to KALT was similar in W and M(3.5v.3.0y,p=0.14) with few occurring within 1y of LT(9v.8%,p=0.89). In univariable competing risk analysis (accounting for death), female sex was associated with a 50% lower need for KALT(95%CI 0.29 – 0.85,p<0.01) which persisted(sHR 0.43,95%CI 0.24–0.75,p<0.01) in multivariable analysis.
Of 1449 W who would have met new SLK criteria, 248(17%)W received SLK and 302(21%)W received LTA. Of these W, 1% who received LTA v. 12% who received SLK died post-LT(median 746v.98d, respectively;p=0.09). In these 550 W who would have met new SLK criteria, W who had LTA experienced better adjusted survival than W who had SLK(HR 0.06,95%CI 0.01–0.25,p<0.01), even when accounting for final MELD.
Conclusion: Under the new SLK policy, W will likely represent a substantially larger % of pts listed for SLK than before. Our data suggest that W meeting the new SLK criteria will not only have a lower need for KALT if they undergo LTA, they will also have a lower adjusted survival if they receive a SLK vs. LTA. These findings highlight the need for monitoring of SLK outcomes, particularly in W, after implementation of the new policy.
CITATION INFORMATION: Cullaro G., Hirose R., Lai J. New SLK Allocation Policy May Impact Transplant Outcomes in Women Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Cullaro G, Hirose R, Lai J. New SLK Allocation Policy May Impact Transplant Outcomes in Women [abstract]. https://atcmeetingabstracts.com/abstract/new-slk-allocation-policy-may-impact-transplant-outcomes-in-women/. Accessed July 9, 2020.
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