In 2017, UNOS established the safety net policy with set criteria for offering kidney transplantation (KT) for patients who developed end stage renal disease between 60 and 365 days after LT. We provide an update on the impact of the policy. We analyzed UNOS data of liver recipients transplanted between 1987 – 2020 who developed acute kidney injury requiring dialysis within 60 days before or after LT and subsequently listed for KT. We identified 407 patients who were listed for kidney after LT before policy and 248 patients after policy. Median waiting time to KT was shorter after policy (324 days vs. 2,827 days). There was a higher proportion of candidates who were listed for subsequent KT within one-year after policy (94.8% vs. 63.6%). KT rate was also higher after policy (87.7 vs. 30.7 per 100 patient-years at risk). Most importantly, we started to observe a net negative kidney utilization in end stage liver disease setting (i.e. summation of SLK and kidney after liver transplant in the first-year after LT has decreased from 1,086 to 876 transplant in 2019). Such findings are consistent with a more efficient system and more appropriate allocation of organs. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
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Walid S Ayoub