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Center variations in patient selection for simultaneous heart-kidney transplantation

Brian I Shaw1, Marya L Samoylova1, Andrew S Barbas1

  • 1Department of Surgery, Duke, University, Durham, North Carolina, USA.

Clinical Transplantation
|February 17, 2022
PubMed

Insights

Patient selection for simultaneous heart-kidney (SHK) transplants varies widely between medical centers. This highlights the need for national guidelines to standardize SHK transplant practices.

Area of Science:

  • Transplantation Medicine
  • Nephrology
  • Cardiology

Background:

  • Simultaneous heart-kidney (SHK) transplantation is increasingly common.
  • Lack of established regulations leads to significant variations in patient selection criteria across transplant centers.

Purpose of the Study:

  • To examine practice trends and center-level variations in patient selection for SHK transplantation.
  • To identify the extent of variability in SHK transplant practices.

Main Methods:

  • Analysis of the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) file.
  • Inclusion of data from January 1, 2004, to March 31, 2019.

Main Results:

  • SHK transplantation rates varied significantly among centers, from 22% to 86% for patients on dialysis.
  • Median estimated glomerular filtration rate (eGFR) for non-dialysis patients receiving SHK varied widely (19-59 mL/min/1.73 m²).
  • Center-level variation in SHK transplantation showed a 57-fold difference between the highest and lowest performing centers after adjusting for covariates.

Conclusions:

  • Substantial center-level variation in SHK patient selection exists.
  • The findings underscore the urgent need for national guidelines to standardize SHK selection criteria.

Keywords:
United Network for Organ Sharingmulti-organ transplantorgan allocationwaitlist management

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