title: Prevalence and outcomes of multiple-listing for cadaveric kidney and liver transplantation.
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.
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA. merionb@umich.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: Mary K
authors.initials: MK
authors.lastname: Guidinger
authors.forename: John M
authors.initials: JM
authors.lastname: Newmann
authors.forename: Mary D
authors.initials: MD
authors.lastname: Ellison
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney; D016030:Kidney Transplantation / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012042:Registries; D012044:Regression Analysis; D012306:Risk; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014180:Transplantation; D016896:Treatment Outcome; D014850:Waiting Lists