New OPTN Simultaneous Liver-Kidney Transplant (SLKT) Policy Improves Racial and Ethnic Disparities

• Published in: Journal of clinical medicine Vol. 9; no. 12; p. 3901
• Main Authors: Goyes, Daniela, Nsubuga, John Paul, Medina-Morales, Esli, Patwardhan, Vilas, Bonder, Alan
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.12.2020; MDPI
• Subjects: Candidates; Clinical medicine; Cultural differences; Ethnicity; Hepatitis C; Hispanic people; International organizations; Ischemia; Kidney diseases; Kidney transplants; Liver diseases; Minority & ethnic groups; Mortality; Patients; Race; Risk assessment; White people; United States > US; disparities; post-graft survival; simultaneous liver-kidney transplant
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9123901

(1) Background: On 10 August 2017, the Organ Procurement and Transplantation Network (OPTN) adopted standardized eligibility criteria to properly determine which transplant candidates should undergo Simultaneous Liver-Kidney Transplant (SLKT). Racial and ethnic disparities have not been examined after 2017. Therefore, using the United Network for Organ Sharing (UNOS), we aim to evaluate post-graft survival outcomes among Caucasians, African Americans, and Hispanics. (2) Methods: Kaplan-Meier curves and Cox regression models are used to compare post-transplant graft survival for Caucasians, African Americans (AAs), and Hispanics. Competing risk analysis is used to evaluate the cumulative incidence of death or re-transplantation with re-transplantation and death as competing risks. (3) Results: On multivariate Cox regression analysis, no differences in graft survival are found in AA (hazard ratio (HR): 1.30; 95% CI: 0.74-2.29 = 0.354) or Hispanics (HR: 1.18; 95% CI: 0.70-2 = 0.520) compared to Caucasians after 2017. On competing risk analysis of the risk of death with re-transplantation as a competing risk, no difference is found between ethnic minorities after 2017. There is a similar finding from competing risk analysis of the risk of re-transplantation with death as a competing risk. (4) Conclusion: After introducing standardized eligibility criteria for SLKT allocation, the post-graft survival outcomes remain similar between the different racial and ethnic groups, displaying the benefits of adopting such policy in 2017.