Transplant professionals have struggled to formulate defensible standards for combined heart-kidney and liver-kidney transplantation (HKTs and LKTs). In these recipients, recovery of native renal function can occur. They require high-quality organ donors, but kidney survival may be shorter than in kidney-alone recipients, who have no chance of recovery of native renal function, more waiting time, and a clear survival benefit with transplantation. It has been left to specialists at individual centers to determine the necessity for the combined procedures. We profiled selection practices using UNOS data from 2012 to 2016.

In 2016, 138 HKTs were performed in the US, an increase of 80% from 77 in 2012. In 2016, 98 HKT recipients received kidneys with KDPI < 35, about 3% of all that were transplanted that year. Almost 30% of HKTs utilized kidneys with KDPI >35.

Over the same interval, LKTs increased 55%, from 462 to 714 per year, and utilized about 15% of all transplanted kidneys with KDPI < 35 in 2016. Forty six percent of LKTs used kidneys with KDPI > 35.

In 2016, selection criteria for the combined procedures appeared quite variable. Among the 20 programs doing 40 or more heart-alone transplants per year, 8 did < 3% and 4 did > 10% more of them as HKTs. Among the 19 liver programs doing over 100 liver-alone transplants/year, 4 centers did < 5% and 5 did > 15% more of them as LKTs.

In summary, [1] in 2016, HKTs and LKTs utilized almost 18% of all available kidneys with KDPI <35. These combined transplants respectively used kidneys with KDPI >35 about 30% and 45% of the time. [2] Many centers appear to allocate kidneys to relatively few borderline heart or liver transplant candidates, while many others are more aggressive. [3] The newly reformulated LKT selection guidelines may also be variably interpreted, and {4} may actually increase kidney use by conservative centers, as every liver recipient with a low post-transplant GFR at 3 months will be prioritized. However, because donor requirements will not be as stringent, fewer low KDPI kidneys may be used. [4] Combined transplants will likely continue to utilize many desirable low KDPI kidneys.

CITATION INFORMATION: Steiner R., Halldorson J. Disparate Candidate Selection Practices and Substantial Use of Low KDPI Kidneys in Combined Heart-Kidney and Liver-Kidney Transplantation, 2012-2016 Am J Transplant. 2017;17 (suppl 3).

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