Findings from a recent study are providing clinicians with an overview of kidney allograft outcomes for kidney after liver transplantation (KALT) versus simultaneous liver-kidney transplantation (SLKT) in the “safety net” era.¹

Leveraging organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) data, the study highlights similar allograft survival between transplantation modalities but reduced estimated glomerular filtration rate (eGFR)

Kidney Allograft Outcomes in Safety Net Recipients

Kidney transplantation offers a significant survival advantage over long-term dialysis. Though, access to transplantation remains unequal, and outcomes for recipients relying on safety net healthcare systems are less understood. Recent research sheds light on how kidney allograft function compares between patients receiving transplants at high-volume centers (KALT – Kidney Allograft Life Transplant) and those transplanted at local centers (SLKT – Standard Life Kidney Transplant).

A study by Garg et al. examined outcomes for over 2,000 safety net recipients who underwent kidney transplantation between 2014 and 2018. Researchers found consistently lower estimated glomerular filtration rate (eGFR) in the KALT group compared to the SLKT group.At one year, the average difference in eGFR was -6.6 mL/min/1.73 m² (95% CI,-8.5 to -4.7; P <.001) in the unadjusted analysis, and -4.7 mL/min/1.73 m² (95% CI,-7.0 to -2.4; P <.001) after propensity score matching. This difference persisted at three years, with mean differences of -6.3 mL/min/1.73 m² (95% CI, -8.8 to -3.7; P <.001) unadjusted and -3.8 mL/min/1.73 m² (95% CI, -6.5 to -1.1; P = .005) after matching.¹

lee and colleagues also reported higher rejection rates in the KALT group at 6 months, 1 year, and 3 years. However, after propensity score matching, these differences weren’t statistically significant at any time point.¹

“Future studies should include longer-term follow-up to determine if kidney allograft health in safety net recipients remains optimal or if allograft failure leads to re-transplantation and/or mortality,” investigators concluded.

¹ Garg, P. et al. Kidney Allograft Outcomes in Safety Net Recipients. American journal of Transplantation. 2024. https://doi.org/10.1111/ajt.17938