Post-Allocation Policy and Changes in Gender Disparities in Access to Simultaneous Liver and Kidney Transplantation
1Nephrology, UCSF, San Francisco, CA, 2Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, Saint Louis, MO, 3Division of General Medical Sciences, Washington University in St Louis, Saint Louis, MO, 4Saint Louis University Center for Abdominal Transplantation,, Saint Louis University, Saint Louis, MO, 5Division of Nephrology, Department of Internal Medicine, Washington University in St Louis, Saint Louis, MO
Meeting: 2022 American Transplant Congress
Abstract number: 1195
Keywords: Allocation, Kidney/liver transplantation, Outcome, Survival
Topic: Clinical Science » Organ Inclusive » 70 - Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Information
Session Name: Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Gender-based differences in receiving simultaneous liver-kidney transplant (SLKT) is not well-understood. We recently found that women are disadvantaged in access to SLKT, especially women not initially listed for SLKT. However, no studies have examined these disparities in SLKT access after the implementation of the SLKT allocation policy in 2017, intended to facilitate equity and utility organ allocation.
*Methods: Using retrospective data from the Organ Procurement and Transplantation Network (OPTN) database, we identified two cohorts of patients on the liver transplant (LT) waiting list with renal dysfunction (RD) from February 28, 2002 to August 9, 2017 (pre-SLK allocation policy) and from August 10, 2017 to March 31, 2020 (post-SLK allocation policy). Multilevel time-to-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT in both cohort groups.
*Results: A total of 23,389 candidates with RD listed for LT only were included and 5,823 candidates with RD listed for SLKT in the pre-SLKT allocation policy era. A total of 9,668 candidates with RD listed for SLKT in the post-SLKT allocation policy era. In the pre-SLKT allocation policy era, females with RD listed only for LT had a 55% lower likelihood of receiving SLKT (multivariable-adjusted hazard ratio, aHR 0.45, 95% confidence interval, CI, 0.28-0.72); and those listed for simultaneous organs had 12% lower likelihood of receiving SLKT (aHR 0.88, 95% CI 0.80-0.96), compared to males (Figure 1). In the post-SLKT allocation policy era, female candidates still had 22% lower likelihood of receiving SLKT (aHR 0.78, 95% CI 0.70-0.88), compared to males (Figure 1).
*Conclusions: Prior to the implementation of the SLKT allocation policy, women had a lower likelihood of receiving SLKT compared to male candidates regardless whether they were listed for SLKT. After the policy´s implementation, these disparities are reduced but persist. This calls for further work on developing new policies that address gender disparities in access to organ transplantation.
To cite this abstract in AMA style:
Peschard G, Wang M, Al-Hosni Y, Lentine K, Chang S, Alhamad T. Post-Allocation Policy and Changes in Gender Disparities in Access to Simultaneous Liver and Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/post-allocation-policy-and-changes-in-gender-disparities-in-access-to-simultaneous-liver-and-kidney-transplantation/. Accessed May 11, 2025.« Back to 2022 American Transplant Congress