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This proposal aims to establish an SLK allocation policy to address various perspectives within the transplant community. It includes updated medical eligibility criteria and will be programmed into UNetSM for operationalization. Monitoring will be done by UNOS staff through medical record documentation requests. The proposal emphasizes the distinction between eligibility and listing criteria. It does not create SLK listing criteria but adds priority based on medical criteria for kidney candidates. Post-public comment changes anticipate improvements in recipient survival with an SLK allocation advantage. The proposal also outlines the working process for multi-organ involving kidney allocation and SLK "Safety Net" policies. Collaboration with various groups and feedback mechanisms have been incorporated into the proposal development.
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Simultaneous Liver Kidney (SLK) Allocation Policy Kidney Transplantation Committee Fall 2015
Number of SLK transplants by year Analyses are based on deceased donor SLK transplants performed during 2005-2013. SLK transplants with other organs were excluded from the tabulation.
What are the goals of this proposal? Main goal: Establish SLK allocation policy that addresses different perspectives within the transplant community
Updated Recommendations KDOQI criteria
How will this be operationalized? Programmed into UNet℠
How will this be monitored? UNOS staff will request documentation in medical record
Important Distinction: Eligibility v. Listing Criteria • Proposal does NOT create SLK listing criteria • Liver candidates can still be registered on kidney waiting list whether they meet proposed medical criteria • Current OPTN policy does NOT require any kidney candidate (kidney alone or kidney + other organs) to meet medical requirements in order to be registered on the kidney waiting list • Transplant programs have complete discretion as to which patients to register on the kidney waiting list • Once registered, kidney candidates are prioritized through match classification or points priority based on medical criteria • SLK medical eligibility criteria will add to the different types of priority applied for different types of kidney candidates
Crude survival advantage of receiving a kidney vs. liver alone p-value=0.0007 Recipient survival Recipient survival * Medians are shown Cohort: recipients Mar 31, 2002 – Dec 21, 2012
How Multi-Organ Involving KI works • If OPO recovers a kidney with liver, heart, lung, or pancreas, must allocate kidney locally as part of local multi-organ combination • OPO has discretion to choose between following combinations: • Local heart/kidney candidate • Local liver/kidney candidate • Local lung/kidney candidate • Pancreas/kidney candidates (local through regional/national zero mismatch offers)
How Multi-Organ Involving KI Will Work if Approved • If OPO recovers a kidney with liver, heart, lung, or pancreas, must allocate kidney locally as part of local multi-organ combination • OPO has discretion to choose between following combinations: • Local heart/kidney candidate • Local liver/kidney candidate (eligible local/regional offers) • Local lung/kidney candidate • Pancreas/kidney candidates (local through regional/national zero mismatch offers)
Kidney patient survival: with vs. without prior liver tx Waiting list survival Recipient survival Time period: Mar 31, 2002 – Dec 31, 2012
Questions? Mark Aeder, MD Committee Chair mark.aeder@uhhospitals.org Gena Boyle Project Liaison gena.boyle@unos.org
Medical Eligibility Criteria (as presented for community feedback)
Recipientsurvival Kidney graft survival Cohort: recipients Mar 31, 2002 – Dec 31, 2012
Constituency Group Feedback (SLK medical eligibility criteria)
Kidney transplants after liver transplants (2005-6/2013)by kidney donor type Analyses are based on first deceased and living donor kidney alone transplants that occurred during 2005-6/2013 and followed a liver alone transplant that was still functioning at the time of the subsequent kidney transplant.
