The impact of multi-organ transplant allocation priority on waitlisted kidney transplant candidates.
multi-organ transplantation
organ allocation
simultaneous heart-kidney transplantation
simultaneous liver-kidney transplantation
transplantation ethics
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
26
10
2020
received:
30
04
2020
accepted:
27
10
2020
pubmed:
4
11
2020
medline:
29
6
2021
entrez:
3
11
2020
Statut:
ppublish
Résumé
Kidney-alone transplant (KAT) candidates may be disadvantaged by the allocation priority given to multi-organ transplant (MOT) candidates. This study identified potential KAT candidates not receiving a given kidney offer due to its allocation for MOT. Using the Organ Procurement and Transplant Network (OPTN) database, we identified deceased donors from 2002 to 2017 who had one kidney allocated for MOT and the other kidney allocated for KAT or simultaneous pancreas-kidney transplant (SPK) (n = 7,378). Potential transplant recipient data were used to identify the "next-sequential KAT candidate" who would have received a given kidney offer had it not been allocated to a higher prioritized MOT candidate. In this analysis, next-sequential KAT candidates were younger (p < .001), more likely to be racial/ethnic minorities (p < .001), and more highly sensitized than MOT recipients (p < .001). A total of 2,113 (28.6%) next-sequential KAT candidates subsequently either died or were removed from the waiting list without receiving a transplant. In a multivariable model, despite adjacent position on the kidney match-run, mortality risk was significantly higher for next-sequential KAT candidates compared to KAT/SPK recipients (hazard ratio 1.55, 95% confidence interval 1.44, 1.66). These results highlight implications of MOT allocation prioritization, and potential consequences to KAT candidates prioritized below MOT candidates.
Identifiants
pubmed: 33140571
doi: 10.1111/ajt.16390
pii: S1600-6135(22)08591-4
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2161-2174Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Formica RN, Aeder M, Boyle G, et al. Simultaneous liver-kidney allocation policy: a proposal to optimize appropriate utilization of scarce resources. Am J Transplant. 2016;16(3):758-766.
Organ Procurement and Transplantation Network (OPTN). National Data. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed December 7, 2019.
Formica RN. Simultaneous liver kidney transplantation. Curr Opin Nephrol Hypertens. 2016;25(6):577-582.
Flechner SM. Simultaneous liver-kidney transplantation: what are our obligations to the kidney only recipient? Curr Transpl Rep. 2017;4(2):110-115.
Asch WS, Bia MJ. New organ allocation system for combined liver-kidney transplants and the availability of kidneys for transplant to patients with stage 4-5 CKD. Clin J Am Soc Nephrol. 2016;12(5):848-852.
Reese PP, Veatch RM, Abt PL, et al. Revisiting multi-organ transplantation in the setting of scarcity. Am J Transplant. 2014;14(1):21-26.
Miles CD, Westphal S, Liapakis A, et al. Simultaneous liver-kidney transplantation: impact on liver transplant patients and the kidney transplant waiting list. Curr Transpl Rep. 2018;5(1):1-6.
Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91-106.
Israni AK, Salkowski N, Gustafson S, et al. New national allocation policy for deceased donor kidneys in the united states and possible effect on patient outcomes. J Am Soc Nephrol. 2014;25(8):1842-1848.
Organ Procurement and Transplantation Network. Policies. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Accessed February 2, 2020.
Organ Procurement and Transplant Network (OPTN), OPTN Ethics Committee. Briefing Paper: Ethical Implications of Multi-Organ Transplants. https://optn.transplant.hrsa.gov/media/2989/ethics_boardreport_201906.pdf. Accessed December 13, 2020.
Rao PS, Schaubel DE, Guidinger MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009;88(2):231-236.
Cheng XS, Stedman MR, Chertow GM, et al. Utility in treating kidney failure in end-stage liver disease with simultaneous liver-kidney transplantation. Transplantation. 2017;101(5):1111-1119.
Choudhury RA, Reese PP, Goldberg DS, et al. A paired kidney analysis of multiorgan transplantation: implications for allograft survival. Transplantation. 2016;101(2):368-376.
Schaffer JM, Chiu P, Singh SK, et al. Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure. Am J Transplant. 2014;14(2):384-396.
Fong T-L, Khemichian S, Shah T, et al. Combined liver-kidney transplantation is preferable to liver transplant alone for cirrhotic patients with renal failure. Transplantation. 2012;94(4):411-416.
Gill J, Shah T, Hristea I, et al. Outcomes of simultaneous heart-kidney transplant in the US: a retrospective analysis using OPTN/UNOS data. Am J Transplant. 2009;9(4):844-852.
Nadim MK, Davis CL, Sung R, et al. Simultaneous liver-kidney transplantation: a survey of US transplant centers. Am J Transplant. 2012;12(11):3119-3127.
Levitsky J, Baker T, Ahya SN, et al. Outcomes and native renal recovery following simultaneous liver-kidney transplantation. Am J Transplant. 2012;12(11):2949-2957.
Locke JE, Warren D, Singer AL, et al. Declining outcomes in simultaneous liver-kidney transplantation in the MELD era. Transplantation. 2008;85(7):935-942.
Sharma P, Shu XU, Schaubel DE, et al. Propensity score-based survival benefit of simultaneous liver-kidney transplant over liver transplant alone for recipients with pretransplant renal dysfunction. Liver Transpl. 2016;22(1):71-79.
Luo X, Massie AB, Haugen CE, et al. Baseline and center-level variation in simultaneous liver-kidney listing in the United States. Transplantation. 2018;102(4):609-615.
Eason JD, Gonwa TA, Davis CL, et al. Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK). Am J Transplant. 2008;8(11):2243-2251.
Organ Procurement and Transplant Network. OPTN Simultaneous Liver Kidney Allocation Policy. https://optn.transplant.hrsa.gov/media/1192/0815-12_SLK_Allocation.pdf. Accessed December 10, 2019.
Stewart DE, Wilk AR, Toll AE, et al. Measuring and monitoring equity in access to deceased donor kidney transplantation. Am J Transplant. 2018;18(8):1924-1935.
Stewart DE, Kucheryavaya AY, Klassen DK, et al. Changes in deceased donor kidney transplantation one year after KAS implementation. Am J Transplant. 2016;16(6):1834-1847.
McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004;350(26):2654-2662.
Gillen DL, Stehman-Breen CO, Smith JM, et al. Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. Am J Transplant. 2008;8(12):2600-2606.
Warady BA, Neu AM, Schaefer F. Optimal care of the infant, child, and adolescent on dialysis: 2014 update. Am J Kidney Dis. 2014;64(1):128-142.
United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD: National Institutes of Health; 2018.
Ng YH, Pankratz VS, Leyva Y, et al. Does racial disparity in kidney transplant wait-listing persist after accounting for social determinants of health? Transplantation. 2019; (epub ahead of print). https://doi.org/10.1097/TP.0000000000003002
Purnell TS, Luo X, Cooper LA, et al. Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014. JAMA. 2018;319(1):49-61.
Taber DJ, Gebregziabher M, Hunt KJ, et al. Twenty years of evolving trends in racial disparities for adult kidney transplant recipients. Kidney Int. 2016;90(4):878-887.
King KL, Husain SA, Jin Z, et al. Trends in disparities in preemptive kidney transplantation in the United States. Clin J Am Soc Nephrol. 2019;14(10):1500-1511.
Chang S-H, Wang M, Liu X, et al. Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States. Transplantation. 2019;103(8):1663-1674.
Mohan S, Chiles MC, Patzer RE, et al. Factors leading to the discard of deceased donor kidneys in the United States. Kidney Int. 2018;94(1):187-198.
Huml AM, Albert JM, Thornton JD, et al. Outcomes of deceased donor kidney offers to patients at the top of the waiting list. Clin J Am Soc Nephrol. 2017;12(8):1311-1320.
Husain SA, King KL, Pastan S, et al. Association between declined offers of deceased donor kidney allograft and outcomes in kidney transplant candidates. JAMA Netw Open. 2019;2(8):e1910312.
Cheng XS, Goldhaber-Fiebert J, Tan JC, et al. Defining a willingness-to-transplant threshold in an era of organ scarcity: simultaneous liver-kidney transplant as a case example. Transplantation. 2020;104(2):387-394.
Wolf JH, Sulewski ME, Cassuto JR, et al. Simultaneous thoracic and abdominal transplantation: can we justify two organs for one recipient? Am J Transplant. 2013;13(7):1806-1816.
Al Riyami D, Alam A, Badovinac K, et al. Decreased survival in liver transplant patients requiring chronic dialysis: a canadian experience. Transplantation. 2008;85(9):1277-1280.
Martin EF, Huang J, Xiang Q, et al. Recipient survival and graft survival are not diminished by simultaneous liver-kidney transplantation: an analysis of the united network for organ sharing database. Liver Transpl. 2012;18:914-929.
Schmitt TM, Kumer SC, Al-Osaimi A, et al. Combined liver-kidney and liver transplantation in patients with renal failure outcomes in the MELD era. Transpl Int. 2009;22(9):876-883.
Organ Procurement and Transplantation Network. Ethical principles of pediatric organ allocation (2014). https://optn.transplant.hrsa.gov/resources/ethics/ethical-principles-of-pediatric-organ-allocation/. Accessed February 1, 2020.
Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-1730.
Organ Procurement and Transplant Network. Final Rule. https://optn.transplant.hrsa.gov/governance/about-the-optn/final-rule/. Accessed January 14, 2020.
Lunsford KE, Bodzin AS, Markovic D, et al. Avoiding futility in simultaneous liver-kidney transplantation: analysis of 331 consecutive patients listed for dual organ replacement. Ann Surg. 2017;265(5):1016-1024.
Petrowsky H, Rana A, Kaldas FM, et al. Liver transplantation in highest acuity recipients: identifying factors to avoid futility. Ann Surg. 2014;259(6):1186-1194.
Musso G, Ganbino R, Tabibian JH, et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med. 2014;11(7):e1001680.
United States Census Bureau. 2013 American Community Survey (ACS). https://www.census.gov/programs-surveys/acs/. Accessed October 8, 2019.