Date: Monday, June 13, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Veterans Auditorium
The introduction of KAS in December 2014 marked an effort to incorporate a longevity metrics into deceased organ allocation by prioritizing retrieved kidneys with the best Kidney Donor Profile Index (KDPI) (0-20) to recipients with the greatest Estimated Post Transplant Survival (EPTS) (0-20). The goal is to maximize kidney lifespan to those recipients expected to have the greatest potential for long-term survival, thus reducing or eliminating the need for retransplantation. However, some patients (e.g., multi-organ, CPRA 99-100%) are prioritized ahead of the EPTS 0-20% group for KDPI 0-20% kidneys. We examined OPTN data on the allocation of these kidneys before vs. after KAS.
All KDPI 0-20 recovered deceased donor kidneys (DDKd) from December 4, 2014-August 31, 2015 (post-KAS) were included (n=2,491). This was compared to an 18 month pre-KAS(6/1/13-12/3/14) cohort (n=4,734) (table 1)).
Table 1 Disposition of Recovered KDPI 0-20% Recovered Deceased Donor Kidneys, Pre vs Post-KAS
|KDPI 0-20 Kidney||Pre KAS #||%||Post KAS #||%|
|CPRA 99-100% EPTS 0-20||31||0.7||68||2.6|
|CPRA 99-100% EPTS >20||71||1.5||278||11.2|
|Prior Living Donor||26||0.5||7||0.3|
|Local EPTS 0-20||650||13.7||904||36.3|
|Local EPTS >20||1807||38.2||196||7.9|
|Non local Peds||31||0.7||13||0.5|
|Non local EPTS 0-20||158||3.3||142||5.7|
|Non local EPTS >20||364||7.7||45||1.8|
Post-KAS, 53.9% of KDPI 0-20% kidneys went to pediatric or EPTS 0-20% kidney-alone recipients, compared to just 28.1% pre-KAS. Of the locally allocated KDPI 0-20 kidneys, EPTS 0-20% recipients received 82.2% (904/1100) Post KAS compared to Pre KAS 26.5% (650/2457). Over a fifth of KDPI 0-20% kidneys were allocated to multi-organ candidates, who precede the entire kidney-alone wait list. Just 2.4% of KDPI 0-20% kidneys were discarded, most often due to biopsy findings, anatomical defects or organ trauma.
Conclusion: Although early in the process, we report a nearly 2-fold increase in the allocation of the kidneys with the expected longest survival to the patients with the greatest EPTS potential. While this shift may impart improved long-term survival of these kidneys, multi-organ recipients continue to divert 22.5% of these more ideal kidneys from the intended longevity algorithm.
CITATION INFORMATION: Aeder M, Turgeon N, Kucheryavaya A, Stewart D. Where Are the KDPI 0-20% Kidneys Going in the New KAS? A Major Allocation Shift. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Aeder M, Turgeon N, Kucheryavaya A, Stewart D. Where Are the KDPI 0-20% Kidneys Going in the New KAS? A Major Allocation Shift. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/where-are-the-kdpi-0-20-kidneys-going-in-the-new-kas-a-major-allocation-shift/. Accessed January 17, 2018.
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