*Purpose: Simultaneous heart-kidney transplantation (SHK) proved its survival benefits in dialysis patients. However, criteria to allocate a kidney for SHK is lacking whereas criteria for simultaneous liver/kidney transplantation (SLK) has been implemented in 2017. Our objective is to determine if SLK criteria could be applicable to SHK.

*Methods: A retrospective observational study was performed on heart-only transplant recipients (HT) between 1/1/2000 – 11/30/2019. The patients were stratified according to two primary criteria for SLK: acute kidney injury (AKI) as determined by an MDRD estimated glomerular filtration rate (eGFR) ≤ 25mL/min/1.73m² or on dialysis for 6 consecutive weeks and is documented at least once every 7 days or by chronic kidney disease (CKD) with an eGFR ≤ 60 ml/min/1.73m² for at least 3 months and an eGFR ≤30 ml/min/1.73m² or on hemodialysis at the time of transplant.

*Results: A total 379 patients underwent HT in the study period. There were 11 individuals that developed stage 5 CKD (eGFR < 15mL/min/1.73m²) or required chronic dialysis in the first year post-transplant. Among the entire cohort, only one patient met AKI criteria and 17 patients met CKD criteria. For the AKI criteria, approximately 20-55% of eGFR measurements were missing at each week in the 6 weeks prior to transplant which may explain the low number that qualified via the AKI criteria. That one individual that qualified with the AKI criteria reached stage 5 CKD or required dialysis in the first year post transplant. For those who met CKD criteria, only 1 of the 17 patients had stage 5 CKD or required dialysis therapy within 1 year after heart transplantation. However, 16 of the 17 patients that met CKD criteria remained dialysis free.

*Conclusions: Using the SLK criteria to determine SHK candidates, most potential candidates did not require dialysis in the first year post HT. Therefore, the criteria for SLK overestimated the need of kidney allocation for HT candidates who had AKI or CKD at the time of HT. More stringent criteria are needed for SHK to properly utilize kidney allografts.

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