Simultaneous Liver‐Kidney Transplant: Long‐Term Management (Steroid Withdrawal and Safety Net Patients)

Wiseman, Alexander C.

doi:10.1002/cld.814

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…132 Safety Net Policies A safety net policy was established for liver-kidney transplantation recipients in 2017. Since 2017, there has been a 16% decrease in simultaneous liver-kidney transplantations with an increase in kidney-after-liver transplantations, 133 suggesting better use of donor organs. A safety net approach also theoretically allows living kidney donation, which not only has superior outcomes compared with a deceased kidney donor but also increases the overall donor pool.…”

Section: Mot Policiesmentioning

confidence: 99%

Dual-Organ Transplantation: Indications, Evaluation, and Outcomes for Heart-Kidney and Heart-Liver Transplantation: A Scientific Statement From the American Heart Association

Kittleson¹,

Sharma²,

Brennan³

et al. 2023

Circulation

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Although heart transplantation is the preferred therapy for appropriate patients with advanced heart failure, the presence of concomitant renal or hepatic dysfunction can pose a barrier to isolated heart transplantation. Because donor organ supply limits the availability of organ transplantation, appropriate allocation of this scarce resource is essential; thus, clear guidance for simultaneous heart-kidney transplantation and simultaneous heart-liver transplantation is urgently required. The purposes of this scientific statement are (1) to describe the impact of pretransplantation renal and hepatic dysfunction on posttransplantation outcomes; (2) to discuss the assessment of pretransplantation renal and hepatic dysfunction; (3) to provide an approach to patient selection for simultaneous heart-kidney transplantation and simultaneous heart-liver transplantation and posttransplantation management; and (4) to explore the ethics of multiorgan transplantation.

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Section: Mot Policiesmentioning

confidence: 99%

Dual-Organ Transplantation: Indications, Evaluation, and Outcomes for Heart-Kidney and Heart-Liver Transplantation: A Scientific Statement From the American Heart Association

Kittleson¹,

Sharma²,

Brennan³

et al. 2023

Circulation

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“…In 2017, a new policy standardized eligibility for simultaneous liver kidney transplants (SLK). Commonly known as the “safety net”, this policy allows patients to undergo LT alone, and if kidney disease persists (dialysis dependence or GFR < 20 2–12 months post‐LT) patients are prioritized for subsequent renal transplant 137 …”

Section: Metabolic Complications Of Liver Transplantmentioning

confidence: 99%

Evolving challenges with long‐term care of liver transplant recipients

Odenwald,

Roth,

Reticker

et al. 2023

Clinical Transplantation

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The number of liver transplants (LT) performed worldwide continues to rise, and LT recipients are living longer post‐transplant. This has led to an increasing number of LT recipients requiring lifelong care. Optimal care post‐LT requires careful attention to both the allograft and systemic issues that are more common after organ transplantation. Common causes of allograft dysfunction include rejection, biliary complications, and primary disease recurrence. While immunosuppression prevents rejection and reduces incidences of some primary disease recurrence, it has detrimental systemic effects. Most commonly, these include increased incidences of metabolic syndrome, various malignancies, and infections. Therefore, it is of utmost importance to optimize immunosuppression regimens to prevent allograft dysfunction while also decreasing the risk of systemic complications. Institutional protocols to screen for systemic disease and heightened clinical suspicion also play an important role in providing optimal long‐term post‐LT care. In this review, we discuss these common complications of LT as well as unique considerations when caring for LT recipients in the years after transplant.

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“…78 After 8 months, the number of SLK performed had decreased by 16%, whereas KALT numbers had increased fivefold (from prior average of 1.4/month to 7.3/month). 79…”

Section: Current Policymentioning

confidence: 99%

“…This KALT population may benefit from aligning immunosuppression and induction strategies, protocol biopsies, and DSA monitoring. 79 Despite this, at least hypothetical interest exists in utilizing the immune-protective effects of a liver graft in kidney transplant. In this case, SLK could be performed instead of KTA to reduce the risk of recurrent immune-mediated kidney graft loss in highly sensitized patients.…”

Section: Slk Transplant For Immunological Purposesmentioning

confidence: 99%

Current and Evolving Indications for Simultaneous Liver Kidney Transplantation

Levitsky

2021

Semin Liver Dis

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This review will discuss the etiologies of kidney disease in liver transplant candidates, provide a historical background of the prior evolution of simultaneous liver–kidney (SLK) transplant indications, discuss the current indications for SLK including Organ Procurement and Transplantation Network policies and Model for End Stage Liver Disease exception points, as well as provide an overview of the safety net kidney transplant policy. Finally, the authors explore unanswered questions and future research needed in SLK transplantation.

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Simultaneous Liver‐Kidney Transplant: Long‐Term Management (Steroid Withdrawal and Safety Net Patients)

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/13-6-reading-wiseman a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/13-6-interview-wiseman the interview with the author

Cited by 12 publications

References 10 publications

Dual-Organ Transplantation: Indications, Evaluation, and Outcomes for Heart-Kidney and Heart-Liver Transplantation: A Scientific Statement From the American Heart Association

Dual-Organ Transplantation: Indications, Evaluation, and Outcomes for Heart-Kidney and Heart-Liver Transplantation: A Scientific Statement From the American Heart Association

Evolving challenges with long‐term care of liver transplant recipients

Current and Evolving Indications for Simultaneous Liver Kidney Transplantation

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