Abstract: SA-PO1214
Trends in Simultaneous Heart-Kidney (SHKT) and Kidney-After-Heart (KAHT) Transplantation in Younger vs. Older Adults Across Policy Eras
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Fenyo, Meredith, New York University, New York, New York, United States
- Zeiser, Laura, New York University, New York, New York, United States
- Lonze, Bonnie E., New York University, New York, New York, United States
- Segev, Dorry L., New York University, New York, New York, United States
- Massie, Allan, New York University, New York, New York, United States
- Stewart, Darren E., New York University, New York, New York, United States
- Husain, Syed Ali, New York University, New York, New York, United States
Group or Team Name
- Center for Surgical & Transplant Applied Research (CSTAR)
Background
In 2023, the OPTN implemented GFR-based eligibility criteria for SHKT listing, in addition to a “safety net” to expedite access to kidney transplant (KT) for heart transplant (HT) recipients who develop early post-HT kidney dysfunction. Creatinine-based eGFR overestimates kidney function in older adults, potentially leading to disproportionate loss of access to SHKT for older HT candidates. We studied whether the OPTN policy change reduced SHKT and increased safety net KT use among older adults.
Methods
Using OPTN data, we identified all candidates waitlisted for SHKT or KAHT (defined as listing for KT ≤1 year of HT) and SHKT and KAHT recipients from 1/1/2019-9/27/2023 (“pre-policy era”) and 9/27/23-12/31/25 (“post-policy era”).
Results
We identified 2492 pre-policy and 1397 post-policy SHKT listings, and 86 pre-policy and 426 post-policy KAHT listings. Median age at SHKT listing was similar between policy eras (57 vs 58 years, p=0.81), while the median age at KAHT listing increased from 52 (IQR 44-61) to 58 years (49-64, p<0.001). Among 1585 pre-and 832 post-policy SHKT recipients, median age at SHKT was similar between policy eras (57 vs 59 years, p=0.11), but among 29 pre-policy and 195 post-policy KAHT recipients, median age at KAHT was 52 (43-63) pre- and 58 years (49-65, p=0.10) post-policy (Figure). The proportion of candidates ≥65 years was unchanged among SHKT registrations (20% vs 20%, p=0.63), SHKT recipients (21% vs. 22%, p=0.6), and KAHT recipients (24% vs 26%, p >0.9) across eras, but rose among KAHT registrations (12% vs 25%, p=0.03) after the policy change.
Conclusion
Following implementation of GFR-based eligibility criteria for SHKT and the KAHT safety net, there was a rise in the proportion of KAHT listings that were older adults. Further policy refinement is necessary to ensure that older adults are not disadvantaged in the SHKT evaluation process due to eGFR equation performance.