Table 3. Key points.

Reduced kidney function is a predictor of adverse outcomes in liver transplant recipients Burden of kidney disease is relatively high in patients with liver disease awaiting transplantation Number of SLK transplantation is on the rise since the introduction of the MELD scoring system for liver allocation in 2002 Indications for SLK transplantation are not precisely defined with center-wide practice variation Measuring kidney function with serum creatinine level has significant limitation in patients with liver disease in whom cystatin-C-based equations may be more reliable but not widely available Kidneys used in SLK allocation tend to have lower KDPI which would otherwise have been allocated to pediatric patients on the waiting list for kidney alone transplantation There is a great need for the standardization of kidney allograft allocation for SLK transplantation in order to balance the benefits of this procedure with the downside of not being able to utilize that kidney for a patient awaiting kidney-alone transplantation The newly proposed and recently implemented policy includes medical eligibility criteria for SLK allocation and a concept of “safety net” for those liver recipients who develop ESRD shortly after transplantation along with a recommendation for regional sharing of kidneys for SLK transplantation This policy is a step in the right direction and should be modified based on new data that will emerge after its implementation

Abbreviations: ESRD, end-stage renal disease; KDPI, kidney donor profile index; MELD, model for end-stage liver disease; SLK, simultaneous liver kidney.