title: Simulation modeling of the impact of proposed new simultaneous liver and kidney transplantation policies.
abstract: BACKGROUND
  Increasing use of kidney grafts for simultaneous liver and kidney (SLK) transplants is causing concern about the most effective utilization of scarce kidney graft resources. This study evaluated the impact of implementing the proposed United Network for Organ Sharing SLK transplant policy on outcomes for end-stage liver disease (ESLD) and end-stage renal disease (ESRD) patients awaiting transplant.
  
  
  METHODS
  A Markov model was constructed to simulate a hypothetical cohort of ESLD patients over a 30-year time horizon starting from age 50. The model applies the different criteria being considered in the United Network for Organ Sharing policy and tallies outcomes, including numbers of procedures and life years after liver transplant alone (LTA) or SLK transplant.
  
  
  RESULTS
  When 1-week pretransplant dialysis duration is required, the numbers of SLK transplants and LTAs would be 648 and 9,065, respectively. If the pretransplant dialysis duration is extended to 12 weeks, there would be 240 SLK transplants and 9,426 LTAs. This change results in a decrease of 6,483 life years among SLK transplant recipients and an increase of 4,971 life years among LTA recipients. However, by increasing the dialysis duration to 12 weeks from 1 week, 408 kidney grafts would be released to the kidney waitlist because of the decline in SLK transplants; this yields 796 additional life years gained among ESRD patients.
  
  
  CONCLUSIONS
  Implementation of the proposed SLK transplant policy could restore access to kidney transplants for patients with ESRD albeit at the detriment of patients with ESLD and renal impairment.
authors.affiliation: 1 Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. 2 Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL. 3 Division of Gastroenterology and Hepatology, Johns Hopkins University, Sibley Memorial Hospital, Washington, DC. 4 Division of Management, Policy and Community Health, University of Texas, School of Public Health, Houston, TX. 5 Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Evanston, IL.
authors.forename: Yaojen
authors.initials: Y
authors.lastname: Chang
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gallon
authors.forename: Kirti
authors.initials: K
authors.lastname: Shetty
authors.forename: Yuchia
authors.initials: Y
authors.lastname: Chang
authors.forename: Colleen
authors.initials: C
authors.lastname: Jay
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
authors.forename: Bing
authors.initials: B
authors.lastname: Ho
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Daniela
authors.initials: D
authors.lastname: Ladner
authors.forename: John
authors.initials: J
authors.lastname: Friedewald
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Gordon
authors.initials: G
authors.lastname: Hazen
authors.forename: Anton I
authors.initials: AI
authors.lastname: Skaro
mesh_terms: D000367:Age Factors; D003198:Computer Simulation; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D011050:Policy Making; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists
references.citation: Transplantation. 2011 Jun 27;91(12):1305-9
references.pmid: 21512431
references.citation: Med Decis Making. 1993 Oct-Dec;13(4):322-38
references.pmid: 8246705
references.citation: Hepatology. 2002 May;35(5):1179-85
references.pmid: 11981768
references.citation: Transplantation. 2008 Apr 15;85(7):935-42
references.pmid: 18408571
references.citation: Transplantation. 2011 Jan 15;91(1):121-7
references.pmid: 21452416
references.citation: Nat Clin Pract Nephrol. 2007 Sep;3(9):507-14
references.pmid: 17717563
references.citation: N Engl J Med. 1996 Mar 14;334(11):693-9
references.pmid: 8594428
references.citation: Curr Opin Organ Transplant. 2010 Jun;15(3):263-8
references.pmid: 20386445
references.citation: Value Health. 2012 Sep-Oct;15(6):812-20
references.pmid: 22999130
references.citation: Transplantation. 2008 Dec 15;86(11):1548-53
references.pmid: 19077888
references.citation: J Urol. 2007 Jun;177(6):2255-9; discussion 2259
references.pmid: 17509333
references.citation: Liver Transpl. 2003 Jul;9(7):741-7
references.pmid: 12827563
references.citation: Transplant Proc. 2010 May;42(4):1194-6
references.pmid: 20534259
references.citation: Hepatology. 1999 Dec;30(6):1434-40
references.pmid: 10573522
references.citation: Acta Chir Belg. 2008 Jan-Feb;108(1):31-4
references.pmid: 18411569
references.citation: Liver Transpl. 2012 Jun;18(6):630-40
references.pmid: 22645057
references.citation: Liver Transpl. 2012 Apr;18(4):395-404
references.pmid: 22287036
references.citation: Am J Transplant. 2006 Sep;6(9):2183-90
references.pmid: 16827789
references.citation: Health Care Manag Sci. 2004 Nov;7(4):331-8
references.pmid: 15717817
references.citation: Transplantation. 2010 Jun 15;89(11):1378-84
references.pmid: 20463650
references.citation: Liver Transpl. 2004 Dec;10(12):1468-75
references.pmid: 15558599
references.citation: Med Decis Making. 2001 Jul-Aug;21(4):257-66
references.pmid: 11475382
references.citation: N Engl J Med. 1999 Dec 2;341(23):1725-30
references.pmid: 10580071
references.citation: Am J Transplant. 2006 Nov;6(11):2651-9
references.pmid: 16939515
references.citation: N Engl J Med. 2003 Sep 4;349(10):931-40
references.pmid: 12954741
references.citation: Transplantation. 2012 Aug 27;94(4):411-6
references.pmid: 22805440
references.citation: Hepatology. 2001 May;33(5):1080-6
references.pmid: 11343235
references.citation: Transplantation. 2010 Jul 15;90(1):52-60
references.pmid: 20626084
references.citation: Liver Transpl. 2005 Sep;11(9):1048-55
references.pmid: 16123966
references.citation: Liver Transpl. 2010 Apr;16(4):440-6
references.pmid: 20205164