Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.
Avera McKennan University Hospital and Transplant Institute, Sioux Falls, South Dakota, USA.
Clin Transplant. 2022 Jul;36(7):e14700. doi: 10.1111/ctr.14700. Epub 2022 Jun 1.
Organ 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.
OPTN 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.
Medical 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.
器官获取与移植网络（OPTN）于 2017 年 8 月 10 日实施了医疗资格和安全网政策，以优化同时肝-肾（SLK）的利用。我们研究了该政策对 SLK 清单和单独接受肝移植（LT）后 1 年内使用的肾脏数量的影响。
OPTN 数据库（2014 年 8 月 10 日至 2020 年 6 月 12 日）对没有先前移植的成年人（N=66709）进行分层，以进行 SLK 或单独 LT 的列表，在列表时具有 LT 前肾功能障碍（eGFR<30 mL/min 或透析）。比较了政策前（2014 年 8 月 10 日至 2017 年 8 月 9 日）与政策后（2017 年 8 月 10 日至 2020 年 6 月 12 日）时期的结果。与政策前相比，政策后 SLK 清单减少（8.7%对 9.6%；P<.001），政策后 SLK 清单的可能性降低了 22%，除了第 6 和第 8 区之外，所有 OPTN 区的清单都减少了，而这两个区的清单则有所增加。在 LT 单独接受者中，LT 前有肾功能障碍（N=3272），政策后第 1 年的累积 1 年概率高于政策前，透析（5.6%对 2.3%；P<.0001）、KT 清单（11.4%对 2.0%；P<.0001）和 KT（3.7%对.25%；P<.0001）。在政策后时期节省了 67（2.4%）个肾脏，分别有 18.1%、16.6%、4.3%和 2.9%来自第 7、2、11 和 1 区。
医疗资格和安全网 OPTN 政策导致 SLK 使用减少，并改善了 LT 单独接受者中 LT 前肾功能障碍的机会。尽管政策后时期有所减少，但 SLK 清单的区域差异仍然存在。尽管在安全网下单独接受 LT 后 1 年内 KT 的使用有所增加，但在政策后时期，使用的肾脏数量减少，而不会影响患者的生存。
