Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA.
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI, USA.
Ann Transplant. 2022 Feb 18;27:e934850. doi: 10.12659/AOT.934850.
BACKGROUND The new simultaneous liver-kidney transplantation (SLK) listing criteria in the United States was implemented in 2017. We aimed to investigate the impact on waitlist and post-transplantation outcomes from changes in the medical eligibility of candidates for SLK after policy implementation in the United States. MATERIAL AND METHODS We analyzed adult primary SLK candidates between January 2015 and March 2019 using the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) registry. We compared waitlist practice, post-transplantation outcomes, and final transplant graft type in SLK candidates before and after the policy. RESULTS A total of 4641 patients were eligible, with 2975 and 1666 registered before and after the 2017 policy, respectively. The daily number of SLK candidates was lower after the 2017 policy (3.25 vs 2.89, P=0.01); 1956 received SLK and 95 received liver transplant alone (LTA). The proportion of patients who eventually received LTA was higher after the 2017 policy (7.9% vs 3.0%; P<0.001). The 1-year graft survival rate was worse in patients with LTA than in those with SLK (80.5% vs 90.4%; P=0.003). The adjusted risk of 1-year graft failure in patients with LTA was 2.01 (95% confidence interval 1.13-3.58, P=0.01) compared with patients with SLK among the SLK candidates. CONCLUSIONS Although the number of registrations for SLK increased, the number of SLK transplants decreased, and the number of liver transplants increased. LTA in this patient cohort was associated with worse post-transplantation outcomes.
美国于 2017 年实施了新的肝-肾联合移植（SLK）候选者名单标准。本研究旨在探讨该政策实施后，SLK 候选者的医学资格变化对等候名单和移植后结局的影响。
我们使用器官获取与移植网络/联合网络器官共享（OPTN/UNOS）登记处，分析了 2015 年 1 月至 2019 年 3 月期间的成人原发性 SLK 候选者。我们比较了政策实施前后 SLK 候选者的等候名单实践、移植后结局和最终移植移植物类型。
共有 4641 例患者符合条件，分别有 2975 例和 1666 例在 2017 年政策之前和之后登记。2017 年政策后，SLK 候选者的日数量较低（3.25 例 vs 2.89 例，P=0.01）；1956 例接受了 SLK，95 例接受了单独的肝移植（LTA）。2017 年政策后，最终接受 LTA 的患者比例较高（7.9% vs 3.0%；P<0.001）。LTA 患者的 1 年移植物存活率低于 SLK 患者（80.5% vs 90.4%；P=0.003）。在 SLK 候选者中，与 SLK 患者相比，LTA 患者 1 年移植物失败的调整风险为 2.01（95%置信区间 1.13-3.58，P=0.01）。
尽管 SLK 的登记人数增加，但 SLK 移植的数量减少，而肝移植的数量增加。在该患者队列中，LTA 与较差的移植后结局相关。
