Date: Sunday, June 2, 2019
Session Name: Concurrent Session: Kidney Deceased Donor Allocation I
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Ballroom B
*Purpose: Placing kidneys quickly might reduce discard. Additionally, a faster allocation system that reduces cold ischemia time would yield benefits: decreased delayed graft function, shorter length of stay, lower transplant costs, less acute rejection. At present kidneys are offered sequentially, one at a time, to the primary transplant candidate. We simulated an alternative system making simultaneously expiring kidney offers to multiple centers, where every center must accept or decline within the same one hour.
*Methods: We simulated offering kidneys simultaneously to varying numbers of centers in small, medium, and large batches. Using SRTR data, we simulated the allocation of 12,933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed each hour of delay decreased probability of acceptance by 5%, and that kidneys are discarded after 20 hours of non-local offers.
*Results: Going from small to large batches increased the number of kidneys accepted from 10,085 (92%) to 10,802 (98%) for low-KDPI, and from 1,257 (65%) to 1,737 (89%) for high-KDPI kidneys. The average number of non-local offers per center per week was 10.1 for small batches and 16.8 for large batches. Using large batch size instead of small batch size for the 12,977 kidneys that we simulated resulted in reduced cold ischemia times and prevented the discard of 1,197 kidneys, while requiring centers to screen about 67% more non-local offers per week.
*Conclusions: Simultaneously expiring offers accelerate kidney allocation and reduce discards when applied to kidneys of any KDPI level. Changing the allocation system by allowing simultaneously expiring offers might result in faster allocation of kidneys and decrease the number of discards, without skipping any candidates and while maintaining an acceptable screening burden.
To cite this abstract in AMA style:Kosztowski M, Mankowski M, Raghavan S, Garonzik-Wang J, Axelrod D, Segev DL, Gentry SE. Accelerating Kidney Allocation: Simultaneously Expiring Offers [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/accelerating-kidney-allocation-simultaneously-expiring-offers/. Accessed December 13, 2019.
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