Overall trends in waiting list registrations prior to KAS have predominately monotonically increased, albeit with varied rates of growth, since 2000. However, as a result of KAS on 12/4/2014, it quickly became evident that kidney transplant programs suddenly and dramatically reduced the number and type of patients being added to the list, though recent data suggests registrations are beginning to approach pre-KAS volumes.

We analyzed KI/KP registrations for 3 years surrounding KAS (2012, 2014, 2016) to assess actual vs. predicted center registration volume. We used a linear regression model, based primarily on historical trends, to predict billable registrations, and compared actual registrations to predicted utilizing a Bayesian analysis of the observed to expected ratio similar to MPSC assessment of center-specific post-transplant outcomes from the SRTR. To better understand listing practices, we also developed a metric of center community need, defined as the ratio of candidates ever waiting over USRDS calculated ESRD county-level prevalence, using counties with at least two candidates waiting at the center or with home zip codes within 100 miles of the center zip code.

There were 192 centers that performed at least 10 KI/KP transplants in all three years with a computable community need metric. The majority of centers were considered overall low scorers (N = 119, 62%), with only 26 (14%) being high scorers and 34 (18%) being low scorers in each of the three years. Centers are well distributed across quadrants, suggesting potential inconsistency among listing behaviors regardless of community burden.

If a center lists more patients than expected, but doesn't meet the burden of the community they are serving, this information can provide center awareness and allow for potential changes in listing behaviors/patient outreach, while centers listing more than expected and experiencing low community need may be able to provide insight into their successful outreach strategies. Future analysis includes seeking engagement from centers in each of the four quadrants to identify awareness, successful outreach strategies, barriers to success, etc., and disseminating best practices with educational initiatives.

CITATION INFORMATION: Wilk A., Urban R., Carrico R. Kidney Registration Volume vs. Expectation: Impact of ESRD Burden and Outreach Am J Transplant. 2017;17 (suppl 3).

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