Early Outcomes With the Liver-kidney Safety Net

BACKGROUND A safety net policy was implemented in August 2017 giving liver transplant alone (LTA) recipients with significant renal dysfunction posttransplant priority for subsequent kidney transplantation (KT). This study was undertaken to evaluate early outcomes under this policy. METHODS Adults undergoing LTA after implementation of the safety net policy and were subsequently listed for KT between 60 and 365 days after liver transplantation contained in UNOS data were examined. Outcomes of interest were receipt of a kidney transplant and post liver transplant survival. Safety net patients were compared to LTA recipients not subsequently listed for KT as well as to patients listed for simultaneous liver kidney transplant (SLK) yet underwent LTA and were not subsequently listed for KT. RESULTS There were 100 patients listed for safety net KT versus 9458 patients undergoing LTA without subsequent KT listing. The cumulative incidence of KT following listing was 32.5% at 180 days. The safety net patients had similar 1-year unadjusted patient survival (96.4% vs. 93.4%; p=0.234) but superior adjusted survival (HR 0.1330.3570.960; p=0.041) versus LTA recipients not subsequently listed for KT. Safety net patients had superior 1-year unadjusted (96.4% vs. 75.0%; p<0.001) and adjusted (HR 0.0390.1260.406 ;p<0.001) survival versus SLK listed patients undergoing LTA without subsequent KT listing. CONCLUSION The safety net appears provide rapid access to KT with good early survival for those able to take advantage of it. Survival of patients unable to qualify for KT listing after LTA needs to be better understood prior to further limitation of SLK, however.