Early Changes to Kidney Distribution Under the New Kidney Allocation System.
1JHU, Baltimore
2Methodist, San Antonio
3Georgetown, Washington.
Meeting: 2016 American Transplant Congress
Abstract number: C70
Keywords: Risk factors
Session Information
Session Name: Poster Session C: Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
In December 2014, the Kidney Allocation System (KAS), a major change to kidney allocation, was implemented, granting increased priority to younger candidates and candidates with CPRA≥98%.
METHODS: We compared discard, access to KT, and post-KT DGF 1/1/2013-12/3/2014 ("pre-KAS") vs 12/4/2014-8/31/2015 ("post-KAS").
RESULTS: Discard increased from 18.2% pre-KAS to 19.7% post-KAS ([chi]2 p<0.001). Discard was unchanged among kidneys with KDPI<70 (logistic regression OR=0.92 1.02 1.14, p=0.7), but discard increased by 29% among kidneys with KDPI≥70 (OR=1.15 1.29 1.43, p<0.01, Figure 1). Using Poisson regression adjusting for candidate characteristics, there was no evidence of overall change in access to DDKT; access improved for African-American (AA) and Hispanic candidates and younger adults, but worsened for older adults (Table). The proportion of recipients with CPRA=100 rose from 1% pre-KAS to 12% immediately post-KAS, then declined to 7% by August 2015 (Figure 2). DGF increased from 24.8% pre-KAS to 29.9% post-KAS (p<0.01).
CONCLUSION: Under KAS, access to DDKT improved for AA and Hispanic candidates and younger adults, but increased discard, transplants to highly sensitized patients, and DGF warrant further monitoring.
| Subgroup |
Transplant IRR >1=better DDKT access post-KAS |
| All registrants | 0.997 1.037 1.087 |
| Non-AA, non-Hispanic | 0.87 0.92 0.96 |
| AA | 1.13 1.19 1.25 |
| Hispanic | 1.05 1.13 1.20 |
| Male | 0.96 1.01 1.05 |
| Female | 1.03 1.09 1.14 |
| ABO type O | 0.99 1.04 1.09 |
| ABO type A | 0.95 1.00 1.05 |
| ABO type B | 0.98 1.06 1.14 |
| ABO type AB | 1.13 1.26 1.41 |
| Age <18 | 0.90 1.03 1.17 |
| Age 18-40 | 1.38 1.47 1.57 |
| Age 41-50 | 1.09 1.17 1.24 |
| Age 51-60 | 0.87 0.93 0.98 |
| Age 61-70 | 0.85 0.90 0.96 |
| Age >70 | 0.68 0.76 0.85 |
CITATION INFORMATION: Massie A, Luo X, Lonze B, Desai N, Bingaman A, Cooper M, Segev D. Early Changes to Kidney Distribution Under the New Kidney Allocation System. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Massie A, Luo X, Lonze B, Desai N, Bingaman A, Cooper M, Segev D. Early Changes to Kidney Distribution Under the New Kidney Allocation System. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/early-changes-to-kidney-distribution-under-the-new-kidney-allocation-system/. Accessed May 21, 2025.« Back to 2016 American Transplant Congress