Background: Transplant centers commonly refuse kidney paired donation (KPD) match offers due to unacceptable crossmatch (XM). To reduce XM refusals a new OPTN KPD histocompatibility policy requiring reporting of all donor antigens, periodic retesting of candidate unacceptables, and specific screening requirements was implemented on 1/21/16.

Methods: XM refusal rates were compared for pre (6/2/14–1/21/16) vs post (1/22/16–9/26/16) policy periods. A logistic regression model analyzed match outcomes of transplanted or not transplanted controlling for the time periods, candidate CPRA, candidate age, donor age, donor BMI, and donor ABO.

Results: XM related refusal rate decreased from 29% (n=1063) pre to 11% (n=262) post policy implementation with a greater decrease in virtual (21% vs 6%) vs physical (8% vs 5%) XM refusals. The policy also significantly increased the log odds of a match proceeding to transplant (0.76, p=0.002). Figure 1 compares the modeled predicted probability of transplant between the periods for CPRA (A), donor BMI (B), and donor age (C). With the exception of the x-axis variable, the other variables are held constant at data set means.

Conclusions: The new KPD histocompatibility policy demonstrated a decline in KPD XM refusal rate while increasing the probability of transplant. Many highly sensitized candidates became ineligible for match runs immediately after implementation and the mean CPRA of matched candidates decreased. The mean CPRA of eligible candidates, however, is now increasing as unacceptables are updated. Longer term analysis will determine whether the increased probability of transplant resulted from the policy's intention vs ineligibility of some sensitized candidates. Further improvements to the program will be based on longer term findings.

CITATION INFORMATION: Leishman R, Aeder M, Leffell M, Murphey C, Reinsmoen N, Saidman S, Sandholm T, Toll A, Harper A, Turgeon N. Effects of New KPD Histocompatibility Policy on Refusal Rate and Transplants. Am J Transplant. 2017;17 (suppl 3).

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