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Abstract: PO2145

Gender Disparities in Access to Simultaneous Liver-Kidney Transplantation in the Pre- vs. Post-Allocation Policy Eras

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

Gender differences in receiving simultaneous liver-kidney transplant (SLKT) is not well-understood. We recently found that women are disadvantaged in access to SLKT, especially women not initially listed for SLKT. No studies have examined these disparities in SLKT access after the implementation of the SLKT allocation policy in 2017, intended to facilitate equity and utility organ allocation.

Methods

Using retrospective data from the Organ Procurement and Transplantation Network (OPTN) database, we identified two cohorts of patients on the liver transplant (LT) waiting list with renal dysfunction (RD) from February 28, 2002 to August 9, 2017 (pre-SLK allocation policy) and from August 10, 2017 to March 31, 2020 (post-SLK allocation policy). Multilevel time-to-competing-events regression adjusting for center effect was used to examine the likelihood of receiving SLKT in both cohorts.

Results

A total of 23,389 candidates with RD listed for LT only were included and 5,823 candidates with RD listed for SLKT in the pre-SLKT allocation policy era. 9,668 candidates with RD listed for SLKT in the post-SLKT allocation policy era. Pre-SLKT allocation policy era, females with RD listed only for LT had a 55% lower likelihood of receiving SLKT (multivariable-adjusted hazard ratio, aHR 0.45, 95% confidence interval, CI, 0.28-0.72); and those listed for simultaneous organs had 12% lower likelihood of receiving SLKT (aHR 0.88, 95% CI 0.80-0.96), compared to males (Figure 1). Post-SLKT allocation policy era, females still had 22% lower likelihood of receiving SLKT (aHR 0.78, 95% CI 0.70-0.88), compared to males (Figure 1).

Conclusion

Prior to the implementation of the SLKT allocation policy, women had a lower likelihood of receiving SLKT compared to male candidates regardless whether they were listed for SLKT. After the policy implementation, these disparities are reduced but persist. This calls for further work on developing new policies that address gender disparities in access to organ transplantation.