US safety-net kidney policy reduced simultaneous heart-kidney transplants with similar one-year outcomes

The Organ Procurement and Transplantation Network (OPTN) introduced a safety-net policy in 2023 that gives priority kidney transplant listing to heart transplant recipients who develop persistent kidney dysfunction within one year of the heart transplant. The aim is to favor isolated heart transplantation over simultaneous heart-kidney transplantation (sHKT) in patients whose kidney dysfunction may be reversible. An analysis of the OPTN registry, published in American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, covered heart transplants performed from 2020 to 2025 sciencedirect.comAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Sociesciencedirect.comOpen source ↗.

Transplant volume after the policy

Among 21,688 heart transplant recipients, 1,133 underwent sHKT before the policy and 877 after it, and 183 received a safety-net kidney transplant. Using interrupted time series analysis of quarterly volume, the authors found a change in the slope of sHKT utilization of -4.45 procedures per quarter (95% CI -5.94, -2.95) after implementation. Over the same period, safety-net kidney transplants rose by 2.52 per quarter (95% CI 1.44, 3.59).

One-year mortality and graft failure

The authors compared one-year mortality and kidney graft failure between sHKT recipients before and after the policy using multivariable Cox models. Mortality was similar (hazard ratio [HR] 0.94, 95% CI 0.68, 1.29), as was kidney graft failure (HR 0.91, 95% CI 0.67, 1.24). According to the registry analysis, sHKT was performed less often after the policy, and these one-year outcomes did not differ between the two groups of recipients.