Sheng Zhou

The OPTN has implemented medical criteria to determine which candidates are most appropriate for simultaneous liver-kidney transplantation (SLK) in comparison to liver-alone transplantation. We investigated prepolicy center-level variation among SLK-listing practice, in light of such criteria. We identified 4,736 SLK-eligible candidates after Share-35 in the U.S. We calculated the proportion of candidates at each center who were listed for SLK within 6 months of eligibility. Multi-level logistic regression and parametric survival model was used to estimate the center-specific probability of SLK-listing, adjusting for patient and center-level characteristics. Among 4,736 SLK-eligible candidates, 64.8% were listed for SLK within 6-months of eligibility. However, the percentage of SLK-listing ranged from 0% to 100% across centers. African American race, male gender, prior transplant history, diabetes, and hypertension were associated with a higher likelihood of SLK-listing. Conversely, older age, was associated with a lower likelihood of SLK-listing. After adjusting for candidate characteristics, the percentage of SLK-listing still ranged from 3.8% to 80.2% across centers; this wide variation persisted even after further adjusting for center-level characteristics. There was significant prepolicy center-level variation in SLK-listing for SLK-eligible candidates. Implementation of standardized SLK listing practices may reduce center-level variation and equalize access for SLK candidates across the US.

New regulations require living kidney donor (LKD) follow‐up for 2 years, but donor retention remains poor. Electronic communication (eg, text messaging and e‐mail) might improve donor retention. To explore the possible impact of electronic communication, we recruited LKDs to participate in an exploratory study of communication via telephone, e‐mail, or text messaging postdonation; communication through this study was purely optional and did not replace standard follow‐up. Of 69 LKDs recruited, 3% requested telephone call, 52% e‐mail, and 45% text messaging. Telephone response rate was 0%; these LKDs were subsequently excluded from analysis. Overall response rates with e‐mail or text messaging at 1 week, 1 month, 6 months, 1 year, and 2 years were 94%, 87%, 81%, 72%, and 72%. Lower response rates were seen in African Americans, even after adjusting for age, sex, and contact method (incidence rate ratio (IRR) nonresponse _2.075.81_16.36, P = .001). Text messaging had higher response rates than e‐mail (IRR nonresponse _0.110.28_0.71, P = .007). Rates of nonresponse were similar by sex (IRR 0.68, P = .4) and age (IRR 1.00, P > .9). In summary, LKDs strongly preferred electronic messaging over telephone and were highly responsive 2 years postdonation, even in this nonrequired, nonincentivized exploratory research study. These electronic communication tools can be automated and may improve regulatory compliance and postdonation care.