The Kidney Allocation System (KAS), implemented in 12/2014, increased regional and national sharing of kidneys. Ideally, broader sharing would also reduce some of the stark geographic disparities in access to deceased donor kidney transplantation (DDKT). The goal of this study was to evaluate whether this has occurred.

METHODS: In a population of 143,058 adult kidney waitlist registrants, we modeled OPO-level rates of DDKT pre-KAS (12/1/2013-12/3/2014) vs post-KAS (12/4/2014-7/2/2016) using SRTR data and multilevel Poisson regression. Using these models, we calculated the median time to transplant in each OPO for a reference patient (age 41-59, male, non-African-American and non-Hispanic, blood type O, CPRA=0), and compared pre-KAS with post-KAS geographic disparity in access to transplant using the median incidence rate ratio (MIRR).

RESULTS: OPO-level median times to transplant for a reference patient were longer post-KAS than pre-KAS (median (IQR) 4.1 (2.9-5.9) years pre-KAS, 5.0 (3.3-6.6) years post-KAS, p<0.001). OPO-level median wait times ranged from 1.1-10.8 years pre-KAS, and from 1.5-14.0 years post-KAS (Figure 1). OPO-level wait times post-KAS were highly correlated with wait times pre-KAS (r=0.9, Figure 2). The MIRR was similar pre-KAS and post-KAS (1.60 vs 1.61, p=0.6), indicating no change in geographic disparity.

CONCLUSION: Geographic disparity in access to DDKT has not changed at all in the KAS era. Targeted policy changes would be necessary to reduce geographic disparity.

CITATION INFORMATION: Zhou S, Massie A, Luo X, Chow E, Bae S, Gentry S, Gustafson S, Wey A, Thompson B, Salkowski N, Snyder J, Segev D. Geographic Disparity in Kidney Transplantation After KAS. Am J Transplant. 2017;17 (suppl 3).

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