Background: In December 2014, UNOS implemented broad sweeping changes in the new Kidney Allocation System (KAS). Recent summary reports by UNOS suggest that nationally, key parts of the new policy have met key proposed goals. The aim of this analysis is to assess the impact of the new KAS at a single center.

Methods: All adult deceased donor (DD) kidney transplant (KT) recipient with at least 6 month graft survival from a single center institution between 2013 and 2015 were analyzed. Cohorts were based on the new KAS start date (pre and post). DD and recipient pre and post-transplant parameters were analyzed through a univariate manner.

Results: The UVA kidney waitlist has steadily declined due to a decrease in new registrations (per 30 days) from 22±2 to 13±1 (p=0.002), which has decreased the overall UVA waitlist by 15%. There were 69 DD organ recipients in the pre and 54 in the post cohort. More patients were transplanted in the post-cohort with longer dialysis exposure (Pre 3.3±2.1 vs Post 5.4±3.1 years p<0.001) and younger age (Pre 56±12 vs Post 51±13 years old p=0.04). More %18-34 year olds were transplanted (4 to 14%) with no difference in overall age group distribution (p=0.13). More African-Americans were transplanted (Pre 34% to Post 41%) vs Caucasians (Pre 61% vs Post 44% p=0.1). KT rates did not differ by gender, renal failure cause, HLA matching, or BMI. Highly sensitized patients (cPRA>98%) were transplanted at greater rates (Pre 2.7% vs Post 7.9% p=0.28). Kidney organs of lower quality (per KDPI) were utilized more (Pre 47±28 vs Post 59±21 p=0.02) and KDPI>85 (Pre 13% vs Post 22% p=0.04). For longevity-matching, 100% of KDPI 0-20% KT went to EPTS Top 20% recipients vs 31% previously (p=0.01). There was no change in EPTS Top 20% receiving a KDPI 0-20% (Pre: 28% vs 30% p=0.67). The new KAS did not affect KDPI>85% use, with 100% of organs transplanted in recipients over 50 years old. There was no difference in cold ischemia time (Pre 20±6 vs Post 19±6 hours p=0.15) nor DGF rates (Pre 29% vs Post 41% p=0.21).

Conclusions: The new KAS has met some key metrics at an institutional level, including prioritizing patients with long dialysis history, highly sensitized, and high quality organ longevity matching. Increased use of high KDPI organs could reflect increased regional sharing and a response to decreased low KDPI organ availability. Centers should individually assess the impact of KAS to optimize DD organ allocation.

CITATION INFORMATION: Agarwal A, Ally W, Maluf D, Pelletier S, Brayman K. Impact of the Kidney Allocation System with Deceased Donor Kidney Transplantation: A Single Center Experience. Am J Transplant. 2016;16 (suppl 3).

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