Abstract

Background:

The 2017 UNOS simultaneous liver-kidney transplant (SLK) policy establishes the minimum eligibility criteria for SLK listing and a mechanism to expedite kidney after liver transplantation (Safety Net). Candidate selection for SLK versus Safety Net requires further refinement. Our AIMS were two-fold: 1) to analyze the pre- and post-liver transplant progress of patients eligible for SLK, who instead underwent liver transplant (LT); 2) to compare the outcomes of these patients with a historical cohort of SLK patients.

Methods:

Single center retrospective chart review was completed for LT recipients with eGFR (estimated glomerular filtration rate) < 35 ml/min at time of LT or had a kidney transplant evaluation episode opened prior to LT from 2017-2022. These patients were compared to patients that received SLK from 2007-2016, prior to the 2017 policy change. Demographic data and clinical data, length of hospital stay, number of hospital days post-transplant, and survival data were collected. Renal recovery was defined as recovery of eGFR to > 20ml/min post LT.

Results:

45 LT recipients who qualified for potential SLK from 2017-2022 and 55 patients who received SLK from 2007-2016 were compared. Of these 45 patients (Safety Net group), 17 patients received a kidney transplant after a liver transplant (KALT), and 28 patients received a liver transplant alone (LTA). Median follow-up time was 6.4 years in the SLK group and 2.2 years in the safety net group. No difference was found in overall three-year post-LT survival between patients who did or did not receive SLK (p=0.14) (Table). Among the 28 patients that received LTA, 19 achieved renal recovery within 12 months, 7 were declined for KALT (4 for frailty and 3 for other causes) and 2 died. Five of these patients remain on dialysis. In the patients with renal recovery, average eGFR 1-year post-transplant was 35 ml/min. In a multivariable logistic regression model adjusted for age and sex, predictors of renal recovery included male sex (p=0.02) and absence of diabetes (p=0.04). Between the KALT and LTA groups, there were no significant differences in days in hospital after transplant, length of ICU stays, number of hospitalizations, or episodes of rejection.

Conclusion:

Safety Net protocol provides similar survival in patients that receive a liver transplant alone compared to a historical SLK cohort. In our cohort, 19 out of 28 potential SLK candidates recovered renal function post LT, with male sex and absence of diabetes predicting recovery.