Date: Saturday, May 30, 2020
Session Name: Poster Session B: Kidney Deceased Donor Allocation
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Simultaneous Liver-Kidney (SLK) allocation policy went into effect on 8/10/17, establishing medical eligibility criteria for adult SLK candidates and creating a “Safety Net” for kidney after liver (KAL) recipients (listed on the kidney (KI) waiting list (WL) within 1-year post-liver (LI) transplant (TX)) who did not recover renal function, or quickly developed advanced renal dysfunction, post-TX.
*Methods: OPTN data was analyzed for SLK and KAL TX pre- (1/1/16-8/9/17) and post- (8/10/17-12/31/18) policy implementation. SLK/KAL WL registrations were analyzed as of 12/31/18.
*Results: As of 12/31/18, 975 (92%) SLK registrations met the eligibility criteria (99% due to Chronic KI Disease (CKD)). Of CKD eligible registrations, 57% qualified via dialysis, 18% eGFR/CrCl 0-<20; 11% eGFR/CrCl 20-<25; 14% eGFR/CrCl 25-30. There was a 9% decrease in SLK TX in the first full year post-implementation from a record 740 in 2017 to 676 in 2018; this is a statistically significant decrease in the average number of SLK TX/month (61.6 pre vs. 55.4 post; p=0.0089). There were no significant impacts to pediatric or KP transplant counts (p=0.1060 and p=0.1895 respectively).
Of 209 KAL registrations, 94 (45%) were eligible for Safety Net priority. There was no significant change in KAL WL mortality rates (25.9 (18.3, 35.5) vs. 18.5 (12.4, 26.6) per 100 patient yrs), but there was a significant 4-fold increase in TX rates pre- vs. post-policy (48.2 (34.2, 65.8) vs. 190.4 (157.1, 228.8) per 100 active patient yrs).
Subsequently, there were 124 KAL TX performed post-policy (Figure 1B); 110 (89%) were allocated in Safety Net priority with the rest allocated based on the candidate’s usual priority. The majority (69%) of KAL TX used KDPI 35-85% KI (no KAL living donor KI TX), and 40% had a reported renal failure diagnosis at TX of Hepatorenal Syndrome.
*Conclusions: The implementation of the SLK policy has slowed the annual increase in the number of SLK TX and the Safety Net priority has directed KI to the immediate post-LI TX recipients in need. To date, the impacts on post-TX outcomes have yet to be determined, and further monitoring is planned as data become available.
To cite this abstract in AMA style:Wilk A, Formica R, Wiseman A, Hirose R, Mulligan D, Stewart D. One Year of the OPTN’s SLK Allocation Policy [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/one-year-of-the-optns-slk-allocation-policy/. Accessed October 24, 2020.
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