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Exploring Disease-Specific Waitlist Outcomes in Simultaneous Liver-Kidney Transplantation

Rikako Oki1, Luckshi Rajendran2, Dean Yonghoon Kim2

  • 1Transplant Institute, Henry Ford Hospital, Detroit, MI, United States.

Transplant International : Official Journal of the European Society for Organ Transplantation
|April 29, 2026
PubMed

Insights

Liver etiology impacts waitlist outcomes in simultaneous liver-kidney transplants (SLKT). Patients with metabolic dysfunction-associated steatohepatitis (MASH) faced higher mortality than alcohol-related liver disease (ALD) before 2020, a disparity lessened by policy changes.

Area of Science:

  • Transplantation research
  • Organ allocation policy
  • Hepatology

Background:

  • Current liver allocation systems do not consider liver etiology for simultaneous liver-kidney transplantation (SLKT).
  • Significant variations in waitlist outcomes exist among different liver disease etiologies.

Purpose of the Study:

  • To evaluate differences in waitlist outcomes for SLKT candidates based on major liver disease etiologies.
  • To assess the impact of the 2020 organ allocation policy change on these disparities.

Main Methods:

  • Analysis of 4,846 adult SLKT candidates listed in the Organ Procurement and Transplantation Network (OPTN) registry from January 2018 to March 2024.
  • Comparison of waitlist mortality and transplantation probability across liver disease groups (ALD, MASH, HCV, biliary).
  • Stratified analysis by MELD score and examination of pre- and post-2020 policy change outcomes.

Main Results:

  • Patients with MASH exhibited higher 1-year waitlist mortality compared to ALD (HR 1.300, p=0.012), particularly in the middle MELD score group (HR 1.365, p=0.044).
  • The disparity in waitlist mortality between MASH and ALD was more pronounced before the 2020 allocation policy change.
  • Waitlist outcomes varied significantly by liver etiology, with the 2020 policy potentially influencing these mortality disparities.

Conclusions:

  • Liver etiology is a critical factor influencing waitlist outcomes in SLKT.
  • The 2020 organ allocation policy revision may have mitigated pre-existing mortality disparities between MASH and ALD patients.
  • Future allocation strategies should consider liver-specific factors for equitable SLKT outcomes.

Keywords:
allocation policy changeliver etiologymetabolic dysfunction-associated steatohepatitissimultaneous liver-kidney transplantationwaitlist outcomes

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