Comparing Simultaneous Liver-Kidney Transplant Strategies: A Modified Cost-Effectiveness Analysis

Area of Science:

• Transplantation Medicine
• Health Economics
• Organ Allocation Policy

Background:

• A historic high of patients with kidney failure undergo liver transplantation in the U.S.
• Optimal timing for kidney transplantation alongside liver transplant remains undetermined.

Purpose of the Study:

• To compare the cost-effectiveness of four kidney allocation strategies for liver transplant recipients.
• To evaluate the impact of different allocation systems on organ utilization and patient outcomes.

Main Methods:

• Modified cost-effectiveness analysis comparing pre-OPTN, OPTN (post-August 2017), "safety net," and "stringent" strategies.
• Measured cost via deceased donor kidney (DDK) deployment and effectiveness via life years (LYs) and quality-adjusted life years (QALYs).
• Model validated using Scientific Registry for Transplant Recipients data.

Main Results:

• The OPTN, safety net, and stringent strategies were found to be on the efficiency frontier.
• Ranked by effectiveness (LY, QALY) and DDK deployment: OPTN > safety net > stringent strategy.
• The pre-OPTN system was outperformed by all alternative strategies, with incremental LY per DDK ranging from 1.30-1.85 and incremental QALY per DDK from 1.11-2.03.

Conclusions:

• The OPTN system is likely to yield superior liver transplant outcomes.
• This improvement comes with increased utilization of DDKs for liver transplant recipients.
• The study quantifies the organ-effectiveness of kidney allocation strategies for liver candidates.