In December 2014, UNOS implemented broad sweeping changes in the Kidney Allocation System (KAS). Recently, UNOS reported that key goals of the new policy have been met with certain “bolus” trends. The purpose of this study is to determine if these findings are applicable at the donor service area (DSA) level.

All adult deceased donor demographics and utilization were obtained from UNOS for a single DSA from August 2014 to September 2016. Cohorts were defined around KAS implementation as follows: pre, early (first six months since implementation), and current (most recent six months). Deceased donor and recipient parameters were analyzed in a univariate manner.

Data were provided from UNOS on the VATB DSA, which represented 286 donors and 570 recovered kidneys. Kidney waiting list registrants steadily fell post KAS (pre: 2320±12 vs. current: 1839±18; p<0.05), representing a 21% decline. New registrations have rebounded to pre-KAS levels (pre: 64±14 vs. current: 55±3; p=0.26) with highly sensitized patients remaining unchanged (pre: 139±2 vs. current 141±2; p=0.78). The percent of blood type B recipients eligible for A2/A2B organs has steadily increased (pre: 0.4% vs current: 20%; p<0.05). Kidney recovery rates distributed by KDPI remained consistent in all eras with a trend in KDPI >85 (pre: 4±1% vs. current: 23±20%; p=0.09). The overall discard rate doubled (pre: 11% vs. current: 26%; p=0.07) and was most pronounced for KDPI 35-85 (pre: 11% vs. current: 29%; p=0.08). The kidney discard rate for KDPI >85 has decreased in this DSA from (pre: 66% vs. current: 56%; p=0.74). Overall, export rates have stabilized, but still remain higher (pre: 4±2 vs. early: 35±9 vs. current: 23±18; p=ns). The kidney export rate of regional sharing of KDPI >85 dropped (early: 19% compared to current: 7%; p=0.01) with concurrent increased local utilization (early: 65% vs. current: 77%; p=0.25). Pediatric transplantation has returned to near baseline levels (pre: 8.6±1.7 vs. early: 1.3±0.8% vs. current: 5.8±0.1%; p=ns). Patients from 18-34 years were transplanted at higher rates (Pre: 5±3% vs. Current: 11±3%; p=0.16).

In summary, similar trends were observed at the DSA level as was seen nationally. The increased high KDPI organ utilization could reflect increased local use and a response to decreased low KDPI organ availability. DSAs and their corresponding transplant centers should individually assess these changes with attention to reversing the trend of rising discard rates.

CITATION INFORMATION: Ally W, Brayman K, Agarwal A. 18 Month Analysis of the Impact of the New Kidney Allocation System on Deceased Donor Kidney Utilization at the Donor Service Area Level. Am J Transplant. 2017;17 (suppl 3).

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