UNOS Policies 9.7 and 8.5G and Kidney Allocation in SLK Transplants

2021 American Transplant Congress

The United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) policies 9.7 and 8.5G, enacted on August 10, 2017, were issued to establish medical criteria for simultaneous liver-kidney (SLK) transplantation and create a safety net for liver transplant recipients. One policy goal was the preservation of higher quality kidneys for kidney transplant candidates considered at high risk. According to J. Oveyssi and colleagues in the department of internal medicine, division of transplant nephrology, UCLA, Los Angeles, California, before the adoption of these policies, nearly half of the kidney grafts transplanted for SLK purposes had a kidney donor profile index of <35%.

The researchers conducted an analysis to examine the impact of the 2017 policies on kidney grafts for liver transplant candidates. Results of the analysis were reported during a virtual session at the 2021 American Transplant Congress in a presentation titled Status of Kidney Allocation in Liver-Kidney Transplant Before and After the UNOS/OPTN Policy.

The researchers used the UNOS/OPTN master datafile to identify kidney transplant recipients who had previously undergone liver transplantation listed between October 1, 1987, and April 1, 2020. Groups were divided based on transplant date of January 1, 2018. Exclusion criteria included receipt of a SLK or previous kidney transplant. The analysis examined the mean and median kidney profile donor index of the kidneys transplanted and the average time to kidney transplant.

During the study period, 12,216 kidney transplants following liver transplant were performed. Of those, 2033 kidney transplants were performed after January 1, 2018. Prior to January 2018, the mean (standard deviation [SD]) and median kidney donor profile index values were 37.5% ( ±26.1%) and 33.0%, respectively. After January 2018, the corresponding values were 39.1% (±24.6%) and 37.0% (P=.008).

A total of 1575 age-matched kidney after liver transplants were performed before 2018 and 260 were performed after 2018. The mean (±SD) and median kidney donor index values before January 2018 were 55.0% (±25.2%) and 58.0%, respectively. The values after 2018 were 56.0% (±25%) and 59.0%, respectively (P=.6). After 2018, the average time to transplant was reduced by 27 days (P=.0001).

In conclusion, the researchers said, “The intended goals of policies 8.5G and 9.7 have been achieved, albeit modestly, since their inception. Additional follow-up is needed to ensure that these policies continue to provide a safety net for liver transplant recipients without disadvantaging at-risk kidney transplant candidates.”

Source: Oveyssi J, Hussain M, Homkrailas P, Bunnapradist S. Status of kidney allocation in liver-kidney transplants before and after the UNOS/OPTN policy. Abstract of a virtual presentation at the American Transplant Congress 2021 (abstract #29), June 5, 2021.