Prevalence and outcomes of multiple-listing for cadaveric kidney and liver transplantation

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.