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Background: In May 2019, liver transplant (LT) allocation policy changed to limit MELD exception points for hepatocellular carcinoma (HCC) to median MELD at transplant minus three (MMaT‐3). We evaluated this policy's impact on waitlist outcomes for HCC candidates, by race and ethnicity, hypothesizing that the introduction of the MMaT‐3 reduced inequities in waitlist outcomes. Methods: Retrospective cohort study of the Scientific Registry for Transplant Recipients, including all adult LT candidates (N = 10 751) who received HCC exception points from May 17, 2017 to May 18, 2019 (pre‐policy; N = 6627) to May 19, 2019 to March 1, 2021 (post‐policy; N = 4124). We compared incidence of LT and waitlist removal for death or becoming too sick pre‐ and post‐policy for non‐Hispanic White, non‐Hispanic Black, Hispanic/Latinx, and Asian patients using competing risk regression adjusted for candidate characteristics. Results: One‐year cumulative incidence of LT decreased significantly pre‐/post‐policy among White (77.4% vs. 64.5%; p <.01) and Black (76.2% vs. 63.1%; p <.01) candidates only, while a 1‐year incidence of death/non‐LT waitlist removal decreased significantly only among Hispanics (13.4% vs. 7.5%; p <.01). After covariate adjustment, the effect of the policy change was a significantly decreased incidence of LT for White (SHR:.63 compared to pre‐policy; p <.001), Black (SHR:.62; p <.001), and Asian (SHR:.68; p =.002), but no change for Hispanic patients. Only Hispanic patients had a significant decrease in death/waitlist removal after the policy change (SHR:.69; p =.04). Compared to White patients in the pre‐policy era, Hispanic (SHR:.88, p <.007) and Asian candidates (SHR:.72; p <.001) had lower unadjusted incidence of LT. This disparity was mitigated in the post‐policy era where Hispanic patients had higher likelihood of LT than Whites (SHR: 1.22; p =.002). For the outcome of death/non‐LT waitlist removal, the only significant difference was a 42% lower incidence of waitlist removal for Asian compared to White patients in the post‐policy era (SHR:.58; p =.03). Conclusion: Among LT recipients with HCC, racial/ethnic subpopulations were differentially affected by the MMAT‐3 policy, resulting in a post‐policy reduction of some of the previous disparities. [ABSTRACT FROM AUTHOR]

Introduction: Incidental kidneys cysts are typically considered benign, but the presence of cysts is more frequent in individuals with other early markers of kidney disease. We studied the association of donor kidney cysts with donor and recipient outcomes after living donor kidney transplantation. Methods: We retrospective identified 860 living donor transplants at our center (1/1/2011–7/31/2022) without missing data. Donor cysts were identified by review of pre‐donation CT scan reports. We used linear regression to study the association between donor cysts and 6‐month single‐kidney estimated glomerular filtration rate (eGFR) increase, and time‐to‐event analyses to study the association between donor cysts and recipient death‐censored graft failure. Results: Among donors, 77% donors had no kidney cysts, 13% had ≥1 cyst on the kidney not donated, and 11% only had cysts on the donated kidney. In adjusted linear regression, cysts on the donated kidney and kidney not donated were not significantly associated with 6‐month single‐kidney eGFR increase. Among transplants, 17% used a transplanted kidney with a cyst and 6% were from donors with cysts only on the kidney not transplanted. There was no association between donor cyst group and post‐transplant death‐censored graft survival. Results were similar in sensitivity analyses comparing transplants using kidneys with no cysts versus 1–2 cysts versus ≥3 cysts. Conclusions: Kidney cysts in living kidney donors were not associated with donor kidney recovery or recipient allograft longevity, suggesting incidental kidney cysts need not be taken into account when determining living donor candidate suitability or the laterality of planned donor nephrectomy. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: To determine the effect of nonchronic, periodic preoperative opioid use on prolonged opioid fills after surgery. Background: Nonchronic, periodic opioid use is common, but its effect on prolonged postoperative opioid fills is not well understood. We hypothesize greater periodic opioid use before surgery is correlated with persistent postoperative use. Methods: We used a national private insurance claims database, Optum's de-identifed Clinformatics Data Mart Database, to identify adults undergoing general, gynecologic, and urologic surgical procedures between 2008 and 2015 (N = 191,043). We described patterns of opioid fills based on dose, recency, duration, and continuity to categorize preoperative opioid exposure. Patients with chronic use were excluded. Our primary outcome was persistent postoperative use, defined as filling an opioid prescription between 91- and 180-days post-discharge. The association between preoperative opioid use and persistent use was determined using multivariable logistic regression, controlling for clinical covariates. Results: In the year before surgery, 41% of patients had nonchronic, periodic opioid fills. Compared with other risk factors, patterns of preoperative fills were most strongly correlated with persistent postoperative opioid use. Patients with recent intermittent use were significantly more likely to have prolonged fills after surgery compared with opioid-naïve patients [minimal use: odds ratio (OR): 2.0, 95% confidence interval (CI) 1.89–2.03; remote intermittent: OR 4.7, 95% CI 4.46–4.93; recent intermittent: OR 12.2, 95% CI 11.49–12.90]. Conclusions: Patients with nonchronic, periodic opioid use before surgery are vulnerable to persistent postoperative opioid use. Identifying opioid use before surgery is a critical opportunity to optimize care after surgery. [ABSTRACT FROM AUTHOR]