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Kidney Week

Abstract: PO2146

Gender-Based Disparities in Access and Survival Outcomes of Simultaneous Liver-Kidney Transplant Among Liver Transplant Candidates with Renal Dysfunction in the United States

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Peschard, Giselle, Washington University in St Louis, St Louis, Missouri, United States
  • Wang, Mei, Washington University in St Louis, St Louis, Missouri, United States
  • Al-Hosni, Yazen, Washington University in St Louis, St Louis, Missouri, United States
  • Lentine, Krista L., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Chang, Su-Hsin, Washington University in St Louis, St Louis, Missouri, United States
  • Alhamad, Tarek, Washington University in St Louis, St Louis, Missouri, United States
Background

The frequency of simultaneous liver-kidney transplantation (SLKT) has risen since the implementation of the Model for End-stage Liver Disease (MELD)-liver allocation system. Gender disparities in access to SLKT and outcomes post-transplantation are not well described. We examined these gender-based disparities in the MELD era.

Methods

We included a retrospective cohort of patients wait-listed for liver transplant (LT) between 2002-2017 with renal dysfunction (RD). Multilevel time-to-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT. Inverse probability of treatment weighted (IPTW) survival analyses were used to analyze posttransplant mortality outcomes. Sensitivity Analysis (SA) performed using 2 alternative definitions of RD for LT candidates: SA(1), either received dialysis or having creatinine ≥2.0 mg/dL at listing for LT, and SA(2), either received dialysis or having eGFR<35 mL/min/1.73 m2 at listing for LT.

Results

Among candidates not listed for SLKT at the time of listing for LT, females had ≥50% lower likelihood of receiving SLKT compared to males (Figure 1). Females continued to have reduced access despite being listed for SLKT. Once transplanted, we found no statistically significant difference in post-transplant survival by sex for SLKT or LT alone recipients (Figure 2).

Conclusion

Prior to the implementation of the SLKT allocation policy, gender disparities were found in access to SLKT but not in post-transplant survival. A tighter gender difference in access to SLKT was found amongst patients listed for SLKT compared to those not listed simultaneously.