ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2025
New kidney-after-heart allocation policy in the United States: Who would benefit from a rescue kidney?
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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Who cites it
2 citing papers in PubMed.
- Delayed Graft Function After Simultaneous Heart-Kidney Transplantation Across Heart Allocation Eras: Predictors and Impact on Kidney Graft Survival in a National Cohort.Clinical transplantation · 2026Article
- Mitigating Risk of Kidney Dysfunction After Heart Transplantation and Therapeutic Approaches.Circulation. Heart failure · 2026Review
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundThe new rescue kidney policy in the United States was implemented in June 2023. To estimate its potential impact, we investigated a historic cohort of heart transplant (HT) recipients who would have been eligible for a kidney-after-heart transplant under this policy.
methodsAdult heart-only recipients from January 1, 2000 to March 31, 2023 in the United Network for Organ Sharing database were categorized by retroactively applying eligibility criteria from the new policy: estimated glomerular filtration rate (eGFR)≤20ml/min, creatinine clearance (CrCl) ≤20ml/min, or dialysis 60-365 days post-HT. We evaluated outcomes of eligible recipients.
resultsOf 45,833 HT recipients, 840 (1.8%) were eligible for a rescue kidney. Eligible recipients had higher median age (58 vs 56 years, p<0.001) and serum creatinine (1.4 vs 1.2, p<0.001), and were more likely to be status 1A in the pre-2018 allocation era (63.4% vs 51.9%, p<0.001) and status 1 in the post-2018 allocation era (13.9% vs 9.1%, p=0.003). Survival at 1 year conditional on 60-day survival was worse for eligible recipients (50.8% vs 96.3%; HR 17.6 [95% CI: 15.8-19.6], p<0.001). Post-HT, 607 (72.3%) eligible recipients were never listed for kidney transplant (KT), of whom 486 (80.1%) died with a median time-to-death of 8.8 months. Among the 233 (27.7%) recipients listed for KT, 65 (27.9%) died/deteriorated on the waitlist and 99 (42.5%) received a KT (median 38.4 months post-HT).
conclusionsHalf of recipients eligible for a rescue kidney did not survive to 1 year post-HT, and >70% were never listed for KT. The effects of the new policy on mitigating mortality in this challenging population will be paramount.
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