Background: The new Simultaneous Liver-Kidney (SLK) allocation policy went into effect on 8/10/17. It established renal medical criteria for patients waiting for SLK transplants and created new allocation priority (“Safety Net”) for patients listed for a kidney within a year of liver transplant (KAL) with prolonged renal dysfunction. We examined early post-implementation results to assess policy performance.

Data and Methods: We compared national pre- (1/1/16-8/9/17) vs. post- (8/10/17-11/21/17) policy data. Monthly transplant counts were normalized per 30 days (Jul 2017 = 7/1/17-8/9/17; Nov 2017 = 11/1/17-11/21/17).

Results: Since the start of eligibility data collection on 5/31/17, the number of SLK registrations on Waitlist has remained stable at 964 as of 11/24/17. Among SLK registrations, 841 (87%) were eligible for SLK allocation; 98% were eligible due to Chronic Kidney Disease (CKD), 0.8% metabolic disease, and 0.7% sustained acute kidney injury. For eligible CKD registrations, 61% were on dialysis and the remaining had qualifying eGFR/CrCl: 0-20 (16%), 21.1-25 (9%), 25.1-30 (14%). SLK registrations listed since 5/31/17 were more likely to be eligible than those listed pre-policy (90% vs. 86%).

On average, there were 62 total SLK transplants ranging from 49 to 70 per month pre-policy compared to 55 post-policy (53 in Aug and Sep, 49 in Oct, and 63 in Nov). The percent of local SLK transplants remained stable (66% pre- vs. 68% post-policy). For pediatrics, for whom renal medical eligibility is not required, on average, 1.2 SLK transplants occurred per month, ranging from 0 to 3 pre-policy compared to 3.1 post-policy (4, 4, 3 and 1.4 in Aug-Nov).

On 11/24/17, 23% of 138 KAL registrations were eligible for the Safety Net. Out of 42 active registrations, 36% were eligible.

There were 27 KAL transplants performed post-policy (vs. 28 pre-policy); 81% of post-policy KAL transplants were allocated by Safety Net priority, while 19% were allocated based on the candidate's usual kidney allocation priority.

Conclusions: Taking into account both SLK and KAL transplants, a slightly smaller percentage of deceased donor kidney transplants have gone to liver recipients post-policy (5.0% vs. 5.3%). The monthly average number of SLK transplants decreased post-policy (55) vs. pre-policy (62). These early results should be interpreted with caution. Further monitoring will be performed to allow more definitive conclusions about policy performance.

CITATION INFORMATION: Kucheryavaya A., Formica R., Turgeon N., Stewart D., Wilk A. An Early Look at the OPTN's New SLK Allocation Policy Am J Transplant. 2017;17 (suppl 3).

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