Simultaneous liver kidney transplantation

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Purpose of review

Simultaneous liver kidney transplantation (SLK) has taken center stage since the initiation of the new kidney allocation system (KAS). This review places SLK in the context of the changing landscape of organ allocation.

Recent findings

The introduction of the Mayo End-Stage Liver Disease score into liver allocation policy in 2002 resulted in a significant increase in the number of SLKs performed in the United States. Except for a brief respite in 2009, the rate of SLK has continued to increase with 2015 seeing 626 SLKs. KAS did not mandate sharing kidneys with regionally shared livers. It was anticipated this would reduce the number of SLKs. Additionally, the Kidney Donor Profile Index in KAS made possible a more granular assessment of the quality of the kidneys being allocated to SLK recipients. This revealed that nearly 50% of Kidney Donor Profile Index kidneys 0.35 or less, those to be allocated to children, were given to SLK recipients and that a significant proportion of them may not need a kidney.


Medical eligibility criteria, rules for the allocation of kidneys simultaneously with livers, and the establishment of a safety net, will provide nephrologists with the framework and authority to decide which liver disease patients truly need a kidney.

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