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Simultaneous Liver Kidney (SLK) Allocation Policy

Simultaneous Liver Kidney (SLK) Allocation Policy. Kidney Transplantation Committee Fall 2015. What problems will the proposal solve?. Number of SLK transplants by year.

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Simultaneous Liver Kidney (SLK) Allocation Policy

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  1. Simultaneous Liver Kidney (SLK) Allocation Policy Kidney Transplantation Committee Fall 2015

  2. What problems will the proposal solve?

  3. 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.

  4. What are the goals of this proposal? Main goal: Establish SLK allocation policy that addresses different perspectives within the transplant community

  5. Did the Committee review prior work and history?

  6. How does the proposal address the problem statement?

  7. SLK Medical Eligibility Criteria

  8. Updated Recommendations KDOQI criteria

  9. How will this be operationalized? Programmed into UNet℠

  10. How will this be monitored? UNOS staff will request documentation in medical record

  11. 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

  12. Proposed SLK Allocation

  13. Anticipated Post-Public Comment Changes—SLK Allocation

  14. 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

  15. 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)

  16. 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)

  17. SLK ‘Safety Net’ Policy

  18. Kidney patient survival: with vs. without prior liver tx Waiting list survival Recipient survival Time period: Mar 31, 2002 – Dec 31, 2012

  19. Recommended ‘Safety Net’ Policy

  20. Other Important ‘Safety Net’ Details

  21. How will this be operationalized/monitored?

  22. How does this proposal support the OPTN Strategic Plan?

  23. Questions? Mark Aeder, MD Committee Chair mark.aeder@uhhospitals.org Gena Boyle Project Liaison gena.boyle@unos.org

  24. Extra SLK slides

  25. Who did the Committee collaborate with?

  26. Medical Eligibility Criteria (as presented for community feedback)

  27. Recipientsurvival Kidney graft survival Cohort: recipients Mar 31, 2002 – Dec 31, 2012

  28. Regional Feedback (SLK medical eligibility criteria)

  29. Constituency Group Feedback (SLK medical eligibility criteria)

  30. Regional Feedback (Safety Net)

  31. Constituency Group Feedback (Safety Net)

  32. The Impact of the Problem by #s

  33. 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.

  34. Multi-Organ Project Timeline

  35. Kidney-Pancreas Allocation

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