Prevalence and Outcomes of Multiple-Listing for Cadaveric Kidney and Liver Transplantation

Authors

  • Robert M. Merion,

    Corresponding author
    1. Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
    2. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, Michigan, USA
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  • Mary K. Guidinger,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, Michigan, USA
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  • John M. Newmann,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, Michigan, USA
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  • Mary D. Ellison,

    1. Organ Procurement and Transplantation Network/United Network for Organ Sharing, Richmond, Virginia, USA
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  • Friedrich K. Port,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, Michigan, USA
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  • Robert A. Wolfe

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, Michigan, USA
    2. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Abstract

Transplant candidates are permitted to register on multiple waiting lists. We examined multiple-listing practices and outcomes, using data on 81 481 kidney and 26 260 liver candidates registered between 7/1/95 and 6/30/00. Regression models identified factors associated with multiple-listing and its effect on relative rates of transplantation, waiting list mortality, kidney graft failure, and liver transplant mortality. Overall, 5.8% (kidney) and 3.3% (liver) of candidates multiple-listed. Non-white race, older age, non-private insurance, and lower educational level were associated with significantly lower odds of multiple-listing. While multiple-listed, transplantation rates were significantly higher for nearly all kidney and liver candidate subgroups (relative rate [RR]= 1.42–2.29 and 1.82–7.41, respectively). Waiting list mortality rates were significantly lower while multiple-listed for 11 kidney subgroups (RR = 0.22–0.72) but significantly higher for 7 liver subgroups (RR = 1.44–5.93), suggesting multiple-listing by healthier kidney candidates and sicker liver candidates. Graft failure was 10% less likely among multiple-listed kidney recipients. Multiple- and single-listed liver recipients had similar post-transplant mortality rates. Although specific factors characterize those transplant candidates likely to multiple-list, transplant access is significantly enhanced for almost all multiple-listed kidney and liver candidates.

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