Early Trends After Safety Net Policy Introduction for Kidney After Lung Transplantation.

Area of Science:

• Nephrology
• Pulmonology
• Transplant Surgery

Background:

• A safety-net policy for kidney-after-lung transplants (KALT) was implemented in the U.S. on June 29, 2023.
• This policy allows lung transplant (LT) candidates with acute kidney injury (AKI) to undergo LT alone, potentially reducing the need for simultaneous lung-kidney transplants (SLKT).

Purpose of the Study:

• To evaluate changes in kidney transplant (KT) and LT practice patterns following the safety-net policy.
• To compare the outcomes of KALT versus SLKT.

Main Methods:

• Utilized the United Nations Organ Sharing (UNOS) registry to identify patients listed for SLKT or KALT.
• Classified KALT as early (≤365 days post-LT) or late (>365 days post-LT).
• Divided the cohort into pre-safety-net and safety-net eras, analyzing delisting risk and 1-year post-LT mortality.

Main Results:

• Since the policy, SLKT decreased, while early-KALT increased, with significantly shorter KT waitlist times (94 vs. 330 days).
• Listing in the safety-net era was associated with a lower risk of delisting from the KT waitlist (aOR 0.34).
• SLKT demonstrated higher 1-year post-LT mortality (22.1%) and post-KT mortality (21.5%) compared to early-KALT (3.2%, 12.5%) and late-KALT (0%, 7.57%).

Conclusions:

• The safety-net policy has led to a decrease in SLKT and an increase in early-KALT, with improved short-term outcomes and reduced delisting.
• Survivorship bias may influence the observed outcomes, necessitating further investigation.
• Prospective studies are required to definitively compare SLKT and KALT outcomes in the current era.