*Purpose: On August 10, 2017 the United Network for Organ Sharing (UNOS) enacted policies 9.7 and 8.5G to establish medical criteria for simultaneous liver-kidney (SLK) and the “safety net”. One of the goals of these policies was to preserve higher quality kidneys for at risk kidney transplant candidates. Prior to these policies nearly half of the kidney grafts transplanted for SLK purposes had a kidney donor profile index of < 35%. We aim to understanding the impact of the policy on kidney grafts for liver transplant candidates.

*Methods: Kidney transplant recipients who had previously undergone liver transplantation listed between October 1 1987 to April 1, 2020 were identified from the UNOS master datafile. Groups were divided based on transplant date of January 1, 2018. Recipients of a SLK or previous kidney transplant were excluded. We examined the mean and median KDPI of the kidneys transplanted and the average time to kidney transplant.

*Results: A total of 12,216 kidney transplants were performed following liver transplant during the study period. A total of 2033 kidney transplants were performed after January 1 2019. The mean (standard deviation) and median KDPI values before January 2018 were 37.5 % (±26.1%) and 33.0% respectively. After January 2018, they were 39.1% (± 24.6%) and 37.0% respectively (p-value 0.008). 1,575 age matched kidney after liver transplants were performed before 2018 and 260 procedures after 2018. The mean (±SD) and median KDPI values before and after January 2018 were 55.0% (±25.2%), 58.0% and 56.0%(±25%) and 59.0%, respectively (p-value 0.6). The average time to transplant was reduced by 27 days after 2018 (p-value 0.0001).

*Conclusions: The intended goals of policies 8.5G and 9.7 have been achieved, albeit modestly, since their inception. Additional follow up is needed to ensure that these policies continue to provide a safety net for liver transplant recipients without disadvantaging at risk kidney transplant candidates.

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