*Purpose: The OPTN Kidney Paired Donation Pilot Program (KPDPP) donor pre-screen tool allows centers to review and pre-accept or pre-refuse potential donors for individual candidates before match runs. Pre-screening is optional unless the candidate’s CPRA is >=90%. The intent of pre-screening is to improve match quality and reduce match refusals, thereby increasing the number of exchanges that proceed to transplant. Our objective was to assess the impact of pre-screening on transplant and refusal rates.

*Methods: We analyzed OPTN data for all KPDPP match offers from 1/1/15-12/31/19 by utilization of pre-screening. We evaluated matches by whether they were pre-accepted or unscreened; pre-refusing a donor precludes the candidate from matching with that donor during the match run.

*Results: The KPDPP made 2463 match offers during the cohort including 2178 offers to KPD candidates (285 were bridge donors or exchange-ending donors). Of matches to KPD candidates, 1024 (47%) were refused, 948 (43.5%) were accepted but fell through due to a refusal elsewhere in the exchange, and 206 (9.5%) resulted in a transplant. 53.9% (N=1175) were pre-accepted; 46.1% (N=1003) were unscreened. Pre-accepted matches had a significantly higher transplant rate vs unscreened matches (11.4% vs 7.2%, p=0.0010) and a significantly lower refusal rate (42% vs 52.9%, p<0.0001). Pre-accepted matches had a significantly lower rate of refusals due to matched donor characteristics (p<0.0001) (Figure 1), notably due to fewer refusals for donor age, height/weight/BMI, and medical history (Figure 2). Crossmatch-related refusal rates were also lower for pre-accepted matches, though not statistically significant (p=0.09), driven by fewer positive virtual crossmatches and fewer matches with an unacceptable number of HLA mismatches. Pre-accepted matches also had fewer candidate-related refusals (p=0.11), driven by fewer refusals due to a candidate’s involvement in a pending exchange with another KPD program.

*Conclusions: Pre-screening increases the likelihood that a KPD match will proceed to transplant, though matches may still fall through due to a refusal elsewhere in the exchange. The most notable impact of pre-screening was a reduction in refusals due to matched donor characteristics, specifically age, body size and medical history. Additional voluntary or policy-required pre-screening could further reduce match refusals.

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