The Advantage of Multiple Listing Continues in the Kidney Allocation System Era

• Published in: Transplantation proceedings 2021-03, Vol.53 (2), p.569-580
• Main Authors: Decoteau, Mary A., Stewart, Darren E., Toll, Alice E., Kurian, Sunil M., Case, Jamie, Marsh, Christopher L.
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Female; Health Plan Implementation; Humans; Incidence; Kidney Transplantation - statistics & numerical data; Logistic Models; Male; Middle Aged; Odds Ratio; Tissue and Organ Procurement - statistics & numerical data; Tissue Donors - supply & distribution; Waiting Lists - mortality
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.10.036

Transplant candidates can be listed at multiple transplant centers to increase the probability of receiving an organ. We evaluated the association between multilisting (ML) status and access to a deceased donor kidney transplant (DDKT) to determine if ML provides a long-term advantage regarding wait-list mortality and recipient outcomes. Candidates between January 2010 and October 2017 were identified as either singly or multiply listed using Organ Procurement and Transplantation Network data and cohorts before and after implementation of the Kidney Allocation System (KAS). Cross-sectional logistic regression was used to assess relationships between candidate factors and ML prevalence (5.4%). Factors associated with ML pre-KAS included having blood type B (reference, type O; odds ratio [OR], 1.20; P < .001), having private insurance (OR, 1.5; P < .001), wait time (OR, 1.28; P < .001), and increasing calculated panel-reactive antibody (cPRA) (reference, cPRA 0-100; OR for cPRA 80-98, 2.83; OR for cPRA 99, 3.47; OR for cPRA 100, 5.18; P < .001). Transplant rates were double for multilisted vs singly listed recipients (adjusted hazard ratio [aHR], 2.16; P < .001). Extra–donor service area ML candidates received transplants 2.5 years quicker than single-listing (SL) candidates, conferring a 42% wait-list advantage. Recipient death (aHR, 0.94; P = .122) and graft failure (aHR, 0.91; P = .006) rates were also lower for ML recipients. In the KAS era, ML continues to increase the likelihood of receiving a DDKT and lower the incidence of wait-list mortality, and it confers a survival advantages over SL. •Transplant candidates can multiply list to increase the probability of receiving an organ. We evaluated if this provides a long-term advantage and improves recipient outcomes.•Multiply listed candidates before and after implementation of the Kidney Allocation System (KAS) were analyzed.•Transplant rates in multilisted recipients were double those of singly listed recipients.•Patient death and graft failure rates were also lower for multilisting recipients.•In the KAS era, multiple listing confers survival advantages over single listing.