*Purpose: Though the chances of long term graft survival are highest with low KDPI kidneys, there is concern that after implementation of the new kidney allocation system (KAS), KDPI 0-35% kidneys may be increasingly allocated to highly sensitized patients, and therefore not have longevity they would if otherwise transplanted into pediatric or 0-mismatch patients.

*Methods: A retrospective analysis of deceased-donor transplants between January 2008- January 2018 was conducted using the UNOS database. Baseline characteristics of recipients of KDPI<35 kidneys in the pre and post-KAS periods were compared using the students t-test or X² analysis for continuous and categorical variables, respectively.

*Results: 49,777 patients were included in the analysis. Recipients of KDPI<35 kidneys were significantly younger in the post-KAS period (42.9 vs. 45.8 years, p<0.05). There was a significantly higher percentage of Black and Hispanic patients receiving KDPI<35 kidneys in the post-KAS period (31.2 vs 27.9% and 19.2 vs. 16.9% respectively). There was a significant increase in the % of KDPI<35 kidneys going to highly sensitized and multi-organ recipients in the post-KAS period, with no significant change for pediatric patients. Rates of delayed graft function (DGF) amongst recipients of KDPI<35 kidneys increased in the post-KAS period (16.2% vs 18.2%, p<0.05). There was no significant change in rates of 6 month or 1-year rejection or of 1 year graft survival.

*Conclusions: The fate of KDPI <35% kidneys changed in the post-KAS period. More allografts have been transplanted into highly sensitized patients, however there have been no significant changes in the proportion of pediatric patients receiving these allografts. Though rates of DGF increased, further study with longer term follow up is needed to assess for graft survival changes from the pre- to post-KAS periods.

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