*Purpose: Effective March 15, 2021, the OPTN launched a new policy for matching kidney and pancreas transplant candidates with organs from deceased donors. The new policy was projected to increase equity in transplant access for candidates nationwide by using a scoring system based on a reference of 250 nautical mile radius from donor hospital. Various factors can influence the transplant rates including wait list size, organ acceptance practices as well as access to transplant centers in rural and socio-economically disadvantaged parts of the country. Small volume centers have short waitlist and candidates lower on the national list. With the current change in allocation, they may be forced to accept high risk kidneys. The new allocation may impact outcomes for such centers to stay active and maintain volumes. We propose to evaluate the impact of the allocation change on the kidney transplant practices at our center situated in rural setting.

*Methods: A cohort study was designed comparing transplant characteristics of all patients undergoing kidney transplant at our center. The study population was all patients who had a kidney transplant after March 15, 2021. The cohort group was all patients who underwent a kidney transplant at our center from Jan 1, 2019 to Dec 31, 2019. The year 2020 was not considered because of COVID-19 pandemic. Data collected included donor demographics, recipient demographics, donor quality indices and recipient allograft function, transplant related complications.

*Results: There were 66 patients in the pre and the 49 in post allocation group. The most common cause of renal failure was diabetes in both. There were no statistically significant differences in recipient demographics. There was a dramatic increase in the number of DCD donors (48% pre vs 80% post, p 0.007). The cold ischemia time was significantly increased (20hr 5m pre vs 23hr 45m post, p 0.002). The serum creatinine trend showed higher serum creatinine at 1, 3 and 6 months post transplant in the post allocation group. Delayed graft function was seen in 3% in pre vs 10% in post group. There was an increase in hospital stay (6 days vs 8 days).

*Conclusions: The new allocation system may increase utilization DCD kidneys. It also prolongs cold ischemia time. This can result in prolonged hospital stay and DGF rates and result in higher serum creatinine levels. The impact of this on low volume centers and rural hospital systems may decrease organ transplant rates in such areas and lead to disparity in transplant access.

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