Background: In December 2014, UNOS implemented broad sweeping changes in the new Kidney Allocation System (KAS). Recent summary reports by UNOS suggest that on a nation level, key parts of the new policy have met key proposed goals. The purpose is to assess the impact of the KAS is generalizable at the donor service area (DSA).

Methods: All adult deceased donor (DD) demographics and utilization was obtained through UNOS for a single DSA from 8/2014-5/2015 representing pre and post KAS implementation cohorts. DD and recipient parameters were analyzed via an univariate manner.

Results: The VATB DSA data represents 259 donors who proceeded to organ donation procedures. Kidney waitlist registrants fell 9% (Pre 2320±12 vs Post 2145­±111 p=0.01) with new additions decreasing by 50% (64±16 vs 38±9 p=0.005). Highly sensitized new additions remained unchanged at 139 per 30 days vs 141 per 30 days (p=0.26). The % eligible for A2/A2B organs has risen post KAS from 0.4% to 8.2% of listed blood B registration. No differences were observed in organ donation rate in terms of donors (10.8±3.5 vs 12.5±4.5 p=ns) or kidneys (21.5±7.2 vs 24.9±9.1 p=ns) per 30 days. Recovery rates rose significantly for KDPI >85 (2.6% vs 20% p=0.004) and fell for KDPI 0-20 (20% vs 14% p=0.42) and KDPI 21-34 (21% vs 13%; p=0.26). Overall discard rates doubled from 11% to 24% (p=0.15) and was most pronounced for KDPI 35-85% (10% to 16%). Discard rates for KDPI >85% remained steady (66% vs 68%) but were higher than the national rate (61.9%). Export rates rose due to regional sharing of KDPI >85 and highly sensitized from 5% to 38% (p=0.001). 1/3 of exported kidneys were not used in primary recipients and an additional 13% were discarded. Of organs transplanted in non-primary recipients, 72% were originally exported for cPRA >98% through regional/national sharing policies. The # of 18-34 year olds transplanted increased (4.7±2.8 vs 16.1±3.1 p=0.03) vs a decline in pediatrics (8.6±1.7% vs 1.3±0.8% p=0.05). No significant changes in African Americans due to baseline higher rates in Virginia (58% vs. 57% p=ns).

Conclusions: Similar trends were observed at the DSA level as the national level. Increased high KDPI organs utilization could reflect increased regional sharing and decreased low KDPI organ availability. Since OPOs were given license to implement aspects of KAS, DSA should individually assess these changes with attention to exporting organ policies.

CITATION INFORMATION: Ally W, Saunders C, Brayman K, Agarwal A. Impact of the Kidney Allocation System with Deceased Donor Kidney Utilization at the DSA Level. Am J Transplant. 2016;16 (suppl 3).

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