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World J Transplant. Sep 18, 2026; 16(3): 119505
Published online Sep 18, 2026. doi: 10.5500/wjt.119505
Published online Sep 18, 2026. doi: 10.5500/wjt.119505
Higher model for end-stage liver disease excluding international normalized ratio scores predict worse kidney graft outcomes in simultaneous heart-kidney transplantation
Marco E Diaz-Cordova, Matthew Rega, Ishani Sharma, Abhay Dhand, Seigo Nishida, Kenji Okumura, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, United States
Ryosuke Misawa, Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
Author contributions: Diaz-Cordova ME and Okumura K contributed to conceptualization, study design, data analysis, data interpretation, and writing-original draft preparation; Rega M contributed to data analysis, data interpretation, and writing-review and editing; Sharma I contributed to data review and manuscript review; Misawa R, Dhand A, and Nishida S contributed to writing-review and editing and critical revisions of the manuscript; all authors reviewed and approved the final version of the manuscript.
Institutional review board statement: This study was considered exempt by our local Institutional Review Board due to the nature of the study.
Informed consent statement: Informed consent was not required.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest and nothing to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The data used in this study were obtained from the United Network for Organ Sharing (UNOS) registry and are not publicly available due to data use agreements. Data may be obtained directly from UNOS with appropriate permissions. The statistical analysis and analytic code used in this study are available from the corresponding author upon request.
Corresponding author: Kenji Okumura, MD, Associate Faculty, Department of Surgery, Westchester Medical Center and New York Medical College, 100 Woods Road, Valhalla, NY 10595, United States. kenji.okumura@wmchealth.org
Received: February 6, 2026
Revised: April 1, 2026
Accepted: June 5, 2026
Published online: September 18, 2026
Processing time: 214 Days and 14.2 Hours
Revised: April 1, 2026
Accepted: June 5, 2026
Published online: September 18, 2026
Processing time: 214 Days and 14.2 Hours
Core Tip
Core Tip: The incidence of simultaneous heart-kidney transplantation (SHKT) has increased substantially in recent years. Early studies suggested benefit, but recent data are conflicting. No reliable prognostic marker exists for this population. The model for end-stage liver disease excluding international normalized ratio (MELD-XI) was previously validated in heart transplantation and cardiac surgery and may serve as a risk-stratification tool. In this study, higher MELD-XI scores were linked to early mortality and kidney graft failure. This supports its potential role in guiding selection between SHKT and kidney-after-heart transplantation under current allocation policies.