Developing simultaneous liver‐kidney transplant medical eligibility criteria while providing a safety net: A 2‐year review of the OPTN's allocation policy. Issue 11 (4th August 2021)

• Record Type: Journal Article
• Authors: Wilk, Amber R.; Booker, Sarah E.; Stewart, Darren E.; Wiseman, Alexander; Gauntt, Katrina; Mulligan, David; Formica, Richard N.
• Is Part Of: American journal of transplantation. Volume 21:Issue 11(2021)
• Page Start: 3593
• Page End: 3607
• Publication Date: 2021-08-04
• Subjects: ethics and public policy -- health services and outcomes research -- kidney (allograft) function/dysfunction -- kidney transplantation/nephrology -- liver allograft function/dysfunction -- liver transplantation/hepatology -- organ allocation -- Organ Procurement and Transplantation Network (OPTN) -- patient survival; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16761
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : The OPTN's simultaneous liver‐kidney (SLK) allocation policy, implemented August 10, 2017, established medical eligibility criteria for adult SLK candidates and created Safety Net kidney allocation priority for liver‐alone recipients with new/continued renal impairment. OPTN SLK and kidney after liver (KAL) data were analyzed (registrations as of December 31, 2019, transplants pre‐policy [March 20, 2015–August 9, 2017] vs. post‐policy [August 10, 2017–December 31, 2019]). Ninety‐four percent of SLK registrations met eligibility criteria (99% CKD: 50% dialysis, 50% eGFR). SLK transplant volume decreased from a record 740 (2017) to 676 (2018, −9%), with a subsequent increase to 728 (2019, 1.6% below 2017 volume). For KAL listings within 1 year of liver transplant, waitlist mortality rates declined post‐policy versus pre‐policy (27 [95% CI = 20.6–34.7] vs. 16 [11.7–20.5]) while transplant rates increased fourfold (46 [32.2–60.0] vs. 197 [171.6–224.7]). There were 234 KAL transplants post‐policy (94% Safety Net priority eligible), and no significant difference in 1‐year patient/graft survival vs. kidney‐alone (patient: 95.9% KAL, 97.0% kidney‐alone [ p = .39]; graft: 94.2% KAL, 94.6% kidney‐alone [ p = .81]). From pre‐ to post‐policy, the proportion of all deceased donor kidney and liver transplants that were SLK decreased (kidney: 5.1% to 4.3%; liver: 9.7% to 8.7%). SLK policy implementation interrupted the longstanding rise in SLK transplants, while Safety Net priority directed kidneys to liver recipients in need with thus far minimal impact to posttransplant outcomes. Abstract : Since implementation of the 2017 simultaneous liver‐kidney policy, the percentage of kidneys used in liver‐kidney transplantation has decreased, the Safety Net provision is directing kidneys to liver recipients in need, and posttransplant outcomes remain generally unchanged. Asrani and Levitsky comment on page 3513‐3515 .