*Purpose: In August 2017, a new simultaneous liver-kidney transplant (SLK) allocation policy and medical eligibility criteria were introduced. These criteria aim to avoid dual organ transplant in patients who may recover their native kidney function. For patients whose renal function fail to recover by 60 days after liver transplant, a ”safety net” policy has been introduced to increase the priority of liver transplant recipients on kidney waiting list. Here we compared waiting time to kidney transplant among patient whose develop acute kidney injury (AKI) requiring dialysis during liver transplant peri-operation before and after safety net policy.

*Methods: The OPTN/UNOS data from 1987-2020 of patient who were listed and had received liver transplant alone which developed AKI requiring dialysis within 30 days before or after liver transplant were included. Patients who were listed for SLK were excluded. Study populations were grouped according to safety net priority offer into before and after safety net policy.

*Results: A total of 8,617 patients who had received liver transplant were listed for kidney transplant. Five hundred and twenty-six patients who had received dialysis within 30 days before or after liver transplant were listed for kidney transplant. There were 446 patients listed before safety net policy and 80 patients listed after safety net policy which 255 (57.2%) and 43 (53.8%) of them subsequently received kidney transplant, respectively. There were 280 patients (62.8%) and 80 patients (100%) listed for subsequent kidney transplant within 1 year before and after safety net policy, respectively. Seventy-three patients (16.4%) died while waiting for kidney transplant before safety net policy and 4 patients (5.0%) died while waiting after safety net policy. Before safety net policy, patients were listed for kidney transplant 255 (0-2472) days after liver transplant compared to 170 (0-363) days after safety net policy (p=0.06). Median waiting time to kidney transplant were 1,006 days before safety net policy and 241 days after safety net policy (P<0.001). There were 65.1% and 90.7% of subsequently transplanted patients receiving kidney transplant within 1 year before and after safety net policy, respectively (p<0.001).

*Conclusions: After a safety net policy was introduced, patients who deemed a candidate for kidney transplant were listed within 365 days to take an advantage of safety net priority offer. None of them were listed after 365 days post liver transplant. Waiting time to kidney transplant after safety net policy were significantly shorter compared to before safety net policy with a significantly higher proportion of patients receiving kidney transplant within 1 year.

« Back to 2021 American Transplant Congress