Evaluating the 2023 safety-net kidney policy: Eligibility and outcomes of heart transplant recipients in the United States.
- 1David Geffen School of Medicine, University of California, Los Angeles, Calif.
- 2Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Calif.
- 3Drexel College of Medicine, Philadelphia, Pa.
Abstract
Objectives
In 2023, a safety-net kidney policy granting priority kidney allocation to heart transplant (HT) recipients with persistent renal dysfunction was implemented. We aim to compare early outcomes of safety-net kidney-eligible HT recipients and simultaneous heart-kidney transplant (SHKT) recipients.Methods
Adults in the United Network for Organ Sharing database between July 2023 and November 2025 were stratified into isolated heart or SHKT groups. Isolated HT recipients were further categorized by safety-net kidney eligibility, as defined by the Organ Procurement and Transplantation Network Policy. The primary outcome was 1-year survival for safety-net kidney-eligible and simultaneous heart-kidney recipients. Secondary outcomes included 6-month mortality and acute cardiac rejection within 1 year.Results
During the study period, there were 309 SHKT recipients and 181 isolated HT recipients who were safety-net kidney-eligible, 67 of whom received a kidney transplant within the study period. One-year survival was similar for safety-net kidney-eligible and SHKT recipients (96.7% vs 93.5%, P = .46). Mortality at 6 months did not differ between groups (2.2% vs 3.2%, P = .51). Acute cardiac rejection within 1 year was higher among safety-net kidney-eligible recipients (17.4% vs 8.1%, P = .01).Conclusions
The safety-net kidney pathway yields comparable 1-year survival compared with SHKT. However, in this early analysis, staged transplantation is associated with higher rates of acute cardiac rejection. Further studies are needed to validate the incidence and persistence of acute cardiac rejection and ascertain longer-term outcomes to better inform timing of renal transplantation for HT recipients.
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BibTeX
@article{zappacosta2026evaluating,
title = {{Evaluating the 2023 safety-net kidney policy: Eligibility and outcomes of heart transplant recipients in the United States.}},
author = {Hedwig Zappacosta and Malini Daniel and Natalie Tan and Peter D Cho and Joseph Song and John P White and Abbas Ardehali},
journal = {JTCVS open},
year = {2026},
month = sep,
doi = {10.1016/j.xjon.2026.102087},
url = {https://europepmc.org/article/MED/42948499},
note = {CC BY},
}
RIS
TY - JOUR
TI - Evaluating the 2023 safety-net kidney policy: Eligibility and outcomes of heart transplant recipients in the United States.
AU - Hedwig Zappacosta
AU - Malini Daniel
AU - Natalie Tan
AU - Peter D Cho
AU - Joseph Song
AU - John P White
AU - Abbas Ardehali
PY - 2026
DA - 2026/09/21
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102087
UR - https://europepmc.org/article/MED/42948499
AB - Objectives In 2023, a safety-net kidney policy granting priority kidney allocation to heart transplant (HT) recipients with persistent renal dysfunction was implemented. We aim to compare early outcomes of safety-net kidney-eligible HT recipients and simultaneous heart-kidney transplant (SHKT) recipients.Methods Adults in the United Network for Organ Sharing database between July 2023 and November 2025 were stratified into isolated heart or SHKT groups. Isolated HT recipients were further categorized by safety-net kidney eligibility, as defined by the Organ Procurement and Transplantation Network Policy. The primary outcome was 1-year survival for safety-net kidney-eligible and simultaneous heart-kidney recipients. Secondary outcomes included 6-month mortality and acute cardiac rejection within 1 year.Results During the study period, there were 309 SHKT recipients and 181 isolated HT recipients who were safety-net kidney-eligible, 67 of whom received a kidney transplant within the study period. One-year survival was similar for safety-net kidney-eligible and SHKT recipients (96.7% vs 93.5%, P = .46). Mortality at 6 months did not differ between groups (2.2% vs 3.2%, P = .51). Acute cardiac rejection within 1 year was higher among safety-net kidney-eligible recipients (17.4% vs 8.1%, P = .01).Conclusions The safety-net kidney pathway yields comparable 1-year survival compared with SHKT. However, in this early analysis, staged transplantation is associated with higher rates of acute cardiac rejection. Further studies are needed to validate the incidence and persistence of acute cardiac rejection and ascertain longer-term outcomes to better inform timing of renal transplantation for HT recipients.
SN - 2666-2736
ER -