Impact of medical eligibility criteria and OPTN policy on simultaneous liver kidney allocation and utilization

AbstractBackgroundOrgan Procurement and Transplantation Network (OPTN) implemented medical eligibility and safety‐net policy on 8/10/17 to optimize simultaneous liver‐kidney (SLK) utilization. We examined impact of this policy on SLK listings and number of kidneys used within 1‐yr. of receiving liver transplantation (LT) alone.Methods and resultsOPTN database (08/10/14‐06/12/20) on adults (N = 66 709) without previous transplant stratified candidates to listings for SLK or LT alone with pre‐LT renal dysfunction at listing (eGFR < 30 mL/min or on dialysis). Outcomes were compared for pre (08/10/14‐08/09/17) vs. post (08/10/17‐06/12/20) policy era. SLK listings decreased in post vs. pre policy era (8.7% vs. 9.6%; P < .001), with 22% reduced odds of SLK listing in the postpolicy era, with a decrease in all OPTN regions except regions 6 and 8, which showed an increase. Among LT‐alone recipients with pre‐LT renal dysfunction (N = 3272), cumulative 1‐year probability was higher in post vs. prepolicy period for dialysis (5.6% vs. 2.3%; P < .0001), KT listing (11.4% vs. 2.0%; P < .0001), and KT (3.7% vs. .25%; P < .0001). Sixty‐seven (2.4%) kidneys were saved in post policy era, with 18.1%, 16.6%, 4.3%, and 2.9% saving from regions 7, 2, 11, and 1, respectively.ConclusionMedical eligibility and safety‐net OPTN policy resulted in decreased SLK use and improved access to LT alone among those with pre‐LT renal dysfunction. Although decreased in postpolicy era, regional variation of SLK listings remains. In spite of increased use of KT within 1‐year of receiving LT alone under safety net, less number of kidneys were used without impact on patient survival in postpolicy era.