Where Are the KDPI 0-20% Kidneys Going in the New KAS? A Major Allocation Shift.
1Univ Hosp Case Med Ctr, Cleveland, OH
2Emory Univ, Atlanta, GA
3UNOS, Richmond, VA.
Meeting: 2016 American Transplant Congress
Abstract number: 213
Keywords: Cadaveric organs, Efficacy, Kidney transplantation
Session Information
Session Name: Concurrent Session: Kidney Transplantation: Allocation, Discard, and HCV
Session Type: Concurrent Session
Date: Monday, June 13, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Veterans Auditorium
The introduction of KAS in December 2014 marked an effort to incorporate a longevity metrics into deceased organ allocation by prioritizing retrieved kidneys with the best Kidney Donor Profile Index (KDPI) (0-20) to recipients with the greatest Estimated Post Transplant Survival (EPTS) (0-20). The goal is to maximize kidney lifespan to those recipients expected to have the greatest potential for long-term survival, thus reducing or eliminating the need for retransplantation. However, some patients (e.g., multi-organ, CPRA 99-100%) are prioritized ahead of the EPTS 0-20% group for KDPI 0-20% kidneys. We examined OPTN data on the allocation of these kidneys before vs. after KAS.
All KDPI 0-20 recovered deceased donor kidneys (DDKd) from December 4, 2014-August 31, 2015 (post-KAS) were included (n=2,491). This was compared to an 18 month pre-KAS(6/1/13-12/3/14) cohort (n=4,734) (table 1)).
Table 1 Disposition of Recovered KDPI 0-20% Recovered Deceased Donor Kidneys, Pre vs Post-KAS
| KDPI 0-20 Kidney | Pre KAS # | % | Post KAS # | % |
| Multi Organ | 1014 | 21.4 | 560 | 22.5 |
| CPRA 99-100% EPTS 0-20 | 31 | 0.7 | 68 | 2.6 |
| CPRA 99-100% EPTS >20 | 71 | 1.5 | 278 | 11.2 |
| Prior Living Donor | 26 | 0.5 | 7 | 0.3 |
| Local Peds | 460 | 9.7 | 219 | 8.8 |
| Local EPTS 0-20 | 650 | 13.7 | 904 | 36.3 |
| Local EPTS >20 | 1807 | 38.2 | 196 | 7.9 |
| Non local Peds | 31 | 0.7 | 13 | 0.5 |
| Non local EPTS 0-20 | 158 | 3.3 | 142 | 5.7 |
| Non local EPTS >20 | 364 | 7.7 | 45 | 1.8 |
| Discards | 122 | 2.6 | 61 | 2.4 |
| Total | 4734 | 100 | 2491 | 100 |
Post-KAS, 53.9% of KDPI 0-20% kidneys went to pediatric or EPTS 0-20% kidney-alone recipients, compared to just 28.1% pre-KAS. Of the locally allocated KDPI 0-20 kidneys, EPTS 0-20% recipients received 82.2% (904/1100) Post KAS compared to Pre KAS 26.5% (650/2457). Over a fifth of KDPI 0-20% kidneys were allocated to multi-organ candidates, who precede the entire kidney-alone wait list. Just 2.4% of KDPI 0-20% kidneys were discarded, most often due to biopsy findings, anatomical defects or organ trauma.
Conclusion: Although early in the process, we report a nearly 2-fold increase in the allocation of the kidneys with the expected longest survival to the patients with the greatest EPTS potential. While this shift may impart improved long-term survival of these kidneys, multi-organ recipients continue to divert 22.5% of these more ideal kidneys from the intended longevity algorithm.
CITATION INFORMATION: Aeder M, Turgeon N, Kucheryavaya A, Stewart D. Where Are the KDPI 0-20% Kidneys Going in the New KAS? A Major Allocation Shift. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Aeder M, Turgeon N, Kucheryavaya A, Stewart D. Where Are the KDPI 0-20% Kidneys Going in the New KAS? A Major Allocation Shift. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/where-are-the-kdpi-0-20-kidneys-going-in-the-new-kas-a-major-allocation-shift/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress