title: A Paired Kidney Analysis of Multiorgan Transplantation: Implications for Allograft Survival.
abstract: BACKGROUND
  United Network for Organ Sharing multiorgan transplantation allocation policy allows sequestration of a kidney by another solid organ regardless of the priority of the candidate for the kidney allograft. The implications of this policy for kidney allograft survival are not well understood.
  
  
  METHODS
  We conducted a retrospective cohort analysis of pairs of deceased donor kidney transplants where 1 kidney was allocated to a simultaneous liver-kidney (SLK) or simultaneous heart-kidney (SHK) recipient and the contralateral kidney to a kidney transplant alone (KTA) recipient (cohort from February 2002 to December 2010). Graft and patient survivals were assessed with Cox regression models.
  
  
  RESULTS
  There were 1998 SLK and 276 SHK transplants with matching KTA transplants. Five-year kidney graft (64% [SLK] vs 75% [KTA], P < 0.001) and patient survivals (66% [SLK] vs 81% [KTA], P < 0.001) were significantly lower in SLK versus KTA recipients of the contralateral kidney. Among the entire cohort of SLK in this analysis, the cumulative difference in graft survival 1 year after transplant was 115 years, and by 5 years, the difference increased to 1062 years. Among the SHK arm of our study, 5-year graft survival (72% [SHK] vs 73% [KTA], P = 0.71) did not significantly differ, although patient survival (75% [SHK] vs 84% [KTA], P = 0.02) was higher in KTA recipients.
  
  
  CONCLUSIONS
  Kidney graft survival is inferior among SLK relative to KTA, but not SHK. Multiorgan transplantation allocation may not be congruent with the intention of new kidney allocation policies that attempt to maximize survival after kidney transplantation.
authors.affiliation: 1 Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA. 2 Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 3 Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 4 Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 5 Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania.
authors.forename: Rashikh A
authors.initials: RA
authors.lastname: Choudhury
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: David S
authors.initials: DS
authors.lastname: Goldberg
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Deirdre L
authors.initials: DL
authors.lastname: Sawinski
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
mesh_terms: D000328:Adult; D064591:Allografts; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult