Effect of Kidney Allocation System on a Solitary, Isolated, Rural Transplant Program
1Glickman Institute, Cleveland Clinic, Cleveland, OH
2Urology and Renal Transplant, Charleston Area Medical Center, Charleston, WV.
Meeting: 2018 American Transplant Congress
Abstract number: B117
Keywords: Donors, Ethics, Kidney transplantation, marginal, Public policy
Session Information
Session Name: Poster Session B: Kidney Deceased Donor Allocation
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
The new kidney allocation system (KAS) was expected to create an impact on smaller, rural and geographically isolated centers.
Methods. We examined the changes by the KAS in our center, retrospectively analyzing deceased donor kidney transplants pre-KAS (1/1/13-12/3/14) and KAS (12/4/14-12/31/16). Median follow up: 38 and 9 months, respectively. X2, Fisher's exact test, t-test were used for statistical analysis.
Results.
| DONOR CHARACTERISTICS | pre-KAS (n=75) | KAS (n=53) | P value |
| Age (mean)
>64 |
42(+17)
7(9%) |
45(+15)
6(11%) |
NS |
| SCD
ECD DCD ECD and DCD |
48(64%)
16(21%) 11(15%) 0 |
21(40%)
14(26%) 17(32%) 1(2%) |
0.02 |
| High Infectious Risk | 6(8%) | 13(25%) | 0.01 |
| KDPI
<0.20 0.21-0.35 0.36-0.85 0.86-1.00 |
23(31%)
9(12%) 33(44%) 10(13%) |
10(19%)
9(17%) 26(49%) 8(15%) |
NS |
| Cold Ischemia Time(hrs)
<11.9 12-21.9 22-31.9 >32 |
14(+13)
29(39%) 38(51%) 7(9%) 1(1%) |
21(+9)
4(8%) 29(55%) 15(28%) 5(9%) |
0.01
0.01 |
| Pump | 15(20%) | 21(40%) | 0.02 |
| Local Kidneys
Import |
75(100%)
0 |
39(74%)
14(26%) |
0.01 |
| RECIPIENT CHARACTERISTICS | Pre-KAS(n=75) | KAS(n=53) | P value |
| Age(mean)
>64 |
54(+12)
12(16%) |
55(+13)
12(23%) |
NS |
| EPTS
N/A 0<0.20 0.21 to 0.35 0.36 to 0.85 0.86 to 1.00 |
1(1%)
16(21%) 14(19%) 40(53%) 4(5%) |
1(2%)
10(19%) 5(9%) 25(47%) 12(23%) |
0.03 |
| PRA
<0.20 0.21-0.34 0.35-0.79 > 0.80 0.98 0.99 1.00 |
67(89%)
4(5%) 1(1%) 3(4%) 0 0 0 |
32(60%)
1(2%) 8(15%) 4(8%) 1(2%) 3(6%) 4(8%) |
0.01 |
| DGF | 8(11%) | 8(15%) | NS |
| Length of Stay(LOS) | 6.8(+3.5) | 8.4(+14.6) | NS |
| 30-day Readmission | 8(11%) | 13(25%) | 0.04 |
| Acute Rejection | 6(8%) | 12(23%) | 0.02 |
| Complications | 21(28%) | 18(34%) | NS |
| Deaths | 2(3%) | 4(8%) | NS |
Conclusions. There were fewer transplants despite acceptance of more ECD/DCD kidneys and longer ischemic times. Higher risk recipients (high EPTS/PRA) were transplanted as well. These changes led to more complications and longer LOS, and significantly more acute rejections and readmissions. As the only transplant program of a geographically isolated community serving a socio-economically depressed population, the KAS may have significant long-term negative consequences on our patients and program.
CITATION INFORMATION: Brown K., Hill S., Lipscomb L., Jones A., Africa J. Effect of Kidney Allocation System on a Solitary, Isolated, Rural Transplant Program Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Brown K, Hill S, Lipscomb L, Jones A, Africa J. Effect of Kidney Allocation System on a Solitary, Isolated, Rural Transplant Program [abstract]. https://atcmeetingabstracts.com/abstract/effect-of-kidney-allocation-system-on-a-solitary-isolated-rural-transplant-program/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress