Background

Prior living donors (PLDs) who develop ESRD post-donation have received priority on the kidney (KI) waiting list (WL) since 9/2/96. The new Kidney Allocation System (KAS) was developed with the intention of maintaining a similar priority for PLDs, while adding elevated priority for CPRA 99-100% patients. This study investigates the impact of KAS on PLDs' access to deceased donor (DD) KIs, including time to transplant and KDPI of the organs they receive.

Methods

We used OPTN data to compare the DD transplant (TX) rate per patient year, Kaplan-Meier median waiting time (MWT), and median Kidney Donor Profile Index (KDPI) of transplanted kidneys for PLDs pre-KAS (12/4/13-12/3/14) vs. post-KAS (12/4/14-10/31/15). Relative risk was approximated as the ratio of post- vs. pre-KAS TX rates.

Results

There were 93 PLDs ever waiting on the KI WL in the pre-KAS cohort (50 newly listed) and 70 PLDs ever waiting in the post-KAS cohort (34 newly listed), with 44 and 32 receiving DD KI transplants, respectively. TX rates per active patient-year and per all patient-years (both active and inactive time) did not significantly change pre- vs. post-KAS. The TX rate per active patient-year was 2.37 in the pre-KAS era vs 2.19 in the post-KAS era – nearly 7 times higher than rates for newly prioritized high CPRA candidates.

The unadjusted relative risk of TX under KAS (vs. pre-KAS) was 0.92 [95% CI: 0.59, 1.46] and 0.99 [0.55, 1.78] for prevalent (ever waiting during the era) and incident (newly listed) patients in active status, respectively.

MWT to DD TX for PLDs listed in the post-KAS era was 93 days, compared to 82 days in the pre-KAS era (p=0.17). This continues to compare favorably to the 3-5 year wait expected for most candidates.

Median KDPI among PLD recipients increased moderately pre- (0.23) vs. post- (0.31) KAS. Still, under KAS, PLDs have received substantially higher quality kidneys than the average recipient (0.46).

Conclusions

Though more CPRA 99-100% patients are being transplanted under KAS, PLDs have maintained their high level of access to kidneys and are receiving high quality kidneys in a timely manner.

CITATION INFORMATION: Wainright J, Kucheryavaya A, Aeder M, Klassen D, Stewart D. No Significant Impact of KAS on Prior Living Kidney Donors' Access to Timely Transplant of High Quality Kidneys. Am J Transplant. 2016;16 (suppl 3).

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