Chronic kidney disease is common in heart and lung transplant patients and for these patients, pre-emptive listing prior to dialysis is desirable.

Patients listed for kidney after heart/lung will have full HLA antibody testing prior to listing. A note will be made of all mismatches with the heart and these will be listed as unacceptable if the patient has DSA directed against them of if there are gaps in the antibody history. Studies have shown that in the absence of detectable HLA-antibodies, repeat mismatches are not associated with worse graft or patient survival. Therefore if a full antibody history is available then mismatches to which the patient has not developed HLA antibodies will not be listed as unacceptable. However if the offered kidney has a repeat mismatch this will be highlighted to the renal unit.

One key consideration for kidney after heart/lung is the type and level of immunosuppression required. This needs to be discussed between the heart and renal teams to agree a strategy.