Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Transplantation. 2018 Apr;102(4):609-615. doi: 10.1097/TP.0000000000001984.
The Organ Procurement and Transplantation Network has implemented medical criteria to determine which candidates are most appropriate for simultaneous liver-kidney (SLK) transplantation in comparison to liver-alone transplantation. We investigated prepolicy center-level variation among SLK listing practice, in light of such criteria.
We identified 4736 SLK-eligible candidates after Share-35 in the United States. We calculated the proportion of candidates at each center who were listed for SLK transplantation within 6 months of eligibility. Multilevel logistic regression and parametric survival model was used to estimate the center-specific probability of SLK listing, adjusting for patient and center-level characteristics.
Among 4736 SLK-eligible candidates, 64.8% were listed for SLK within 6 months of eligibility. However, the percentage of SLK listing ranged from 0% to 100% across centers. African American race, male sex, transplant history, diabetes, and hypertension were associated with a higher likelihood of SLK listing. Conversely, older age was associated with a lower likelihood of SLK listing. After adjusting for candidate characteristics, the percentage of SLK listing still ranged from 3.8% to 80.2% across centers; this wide variation persisted even after further adjusting for center-level characteristics.
There was significant prepolicy center-level variation in SLK listing for SLK-eligible candidates. Implementation of standardized SLK listing practices may reduce center-level variation and equalize access for SLK candidates across the United States.
器官获取与移植网络已经实施了医疗标准，以确定哪些候选人最适合进行同时肝-肾（SLK）移植，而不是单独进行肝移植。我们根据这些标准，调查了 SLK 列表实践在政策实施前的中心层面的差异。
我们在美国的 Share-35 后确定了 4736 名 SLK 合格的候选人。我们计算了每个中心中符合 SLK 移植条件的候选人在 6 个月内被列入 SLK 移植名单的比例。使用多水平逻辑回归和参数生存模型，根据患者和中心层面的特征，估计中心特异性的 SLK 列表概率。
在 4736 名 SLK 合格的候选人中，有 64.8%在符合条件后的 6 个月内被列入 SLK 名单。然而，各中心列入 SLK 名单的百分比从 0%到 100%不等。非裔美国人、男性、移植史、糖尿病和高血压与更高的 SLK 列表概率相关。相反，年龄较大与 SLK 列表概率较低相关。在调整了候选人特征后，各中心列入 SLK 名单的百分比仍从 3.8%到 80.2%不等；即使进一步调整了中心层面的特征，这种广泛的差异仍然存在。
在 SLK 合格候选人中，SLK 列表的政策实施前的中心层面差异显著。实施标准化的 SLK 列表实践可能会减少中心层面的差异，并在美国范围内平等地为 SLK 候选人提供机会。
