Background: In the Organ Procurement and Transplantation Network's (OPTN) new kidney allocation system, kidney offers are screened by setting for each candidate a maximum acceptable KDPI (mKDPI), which can vary by offer type: (local, import) and (0MM, non-0MM). Patients must consent to receive KDPI>85 offers.

Methods: mKDPI values were examined for the 142 kidney programs that added 5 or more candidates to the waitlist from 5/27/14-10/31/14 (n=9,772 registrations). Kidney offer acceptance rates were explored. Analyses were based on OPTN data as of 11/14/14.

Results: The most common mKDPI values for local, non-0MM offers were 85 (61%) and 100 (25%). While 32 (23%) of 142 programs entered the same mKDPI value for each of their patients, some programs (e.g., ABCD-TX1, Fig 1) appear to have stratified mKDPI values based on clinical factors such as candidate age. Nationally, average mKDPI increased from 67 for pediatrics age <5 to 94 for age 76+. Some pediatrics were given mKDPI values of 20 or 35. Only 13 programs set mKDPI higher for local vs imports. Fig 2 highlights one such center (EFGH-TX1), which set most patients' mKDPI to 100% for local and 85% for non-local offers, consistent with its history of accepting 0 of 20 non-local, KDPI>85 kidneys offered since 2007. 10 programs set higher mKDPI for 0MM vs non-0MM.

Conclusions: Some centers appear to have deliberate strategies for setting mKDPI based on factors such as patient age and offer type. Programs that will continue to refuse imported, high-KDPI kidneys may benefit by setting lower mKDPI values for non-local offers. Effective use of this new screening tool can avoid unwanted offers, accelerate organ placement, and reduce kidney discard rates.

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