Introduction: Renal grafts used in simultaneous kidney liver (SLK) transplants are allocated on “center based” arbitrary clinical criteria without entering the kidney allocation algorithm. The goal of the study is to evaluate differences in transplant outcomes of kidneys allocated to SLK patients compared to those allocated to kidney only (KI) patients of varying kidney donor profile indexes (KDPI).

Methods: 2000-2014 UNOS data was queried for matched donor pairs where one kidney went to a KI and the other to a SLK. All re-transplants and patients receiving additional transplant allografts were excluded. Patients were divided based on allograft quality according KDPI: KDPI<20%, KDPI 20-34%, KDPI 35-85%, KDPI>85%. Demographics data and outcomes (patient and death-censored graft survival) were compared between SLK & KI recipients from the same donor.

Results: 2218 donor pairs were included (3.6% had KDPI<20%, 16.6% had KDPI 20-34%, 60.7% had KDPI 35-84% & 19.1% had KDPI>85%). In SLKs, MELD score, cause of liver failure, waitlist time, dialysis duration, BMI and age were comparable across KDPIs. Decreased 1, 5, & 10-year patient & graft survival was noted in SLK recipients with increasing KDPI. Improved patient survival was observed at 1, 5, & 10 years for SLK recipients with KDPI <34% when compared to those with KDPI>35% (p<0.001). Better patient survival was noted for SLK recipients with KDPI 35-85% compared to KDPI >85% (p<0.001). Graft survival was improved for recipients of KDPI<34% compared to KDPI>35% (p<0.001) and patients with KDPI 35-85% compared to KDPI >85% (p<0.001). Liver Donor Profile Index (LDPI) increases as KDPI increases. In KIs, patient 10 year survival was lower with KDPI >85% kidneys compared to the other groups (50.3% vs. 68.7% p<0.01). Graft survival was not different among the groups (NS).

Conclusion: The negative influence of high KDPI on patient and graft survival is greater in SLK recipients when compared to KI recipients. 80% of SLK recipients received a kidney with a KDPI>35%, and they consistently had worse patient and graft survival compared to SLK patients with KDPI<34%. The interaction between KDPI and LDPI and the impact of both factors on patient and graft survival are underway. This analysis provides some guidance in determining how kidneys are fairly distributed between ESRD and ESLD patients to maximize utilization of limited resources.

CITATION INFORMATION: Zens T, Danobeitia J, Stahler P, Leverson G, Redfield R, D'Alessandro A, Fernandez L. Kidney Quality Dramatically Influences Patient and Death Censored Graft Survival in SLK Recipients. Am J Transplant. 2017;17 (suppl 3).

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