Session Name: Poster Session B: Kidney Deceased Donor Allocation
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The Kidney Allocation Score (KAS) was developed to improve matching of donor and recipients; we examine the effect of this change on transplantation practice and outcomes.
*Methods: Data from the UNOS STAR files was used to identify first-time adult of a deceased donor kidney-alone transplant pre-KAS (Jan 2011-Dec 2014) and post-KAS (Jan 2015-Dec 2017). Demographic variables were summarized and compared for donor and recipient. Patient and graft survival were compared by Kaplan-Meier log-rank test. Cumulative incidence function was used to estimate the probability of graft loss with death as a competing event. Follow-up was truncated to 24 months.
*Results: 26,612 transplants were performed pre-KAS, and 30,701 post-KAS. Compared to pre-KAS, post-KAS donors were younger, less likely to have diabetes or hypertension, and more likely to die of anoxic brain injury. Compared to pre-KAS, post-KAS gender and ethnic disparities narrowed with more female and African-American recipients. Recipients were also more likely to be diabetic, and had a higher calculated percent reactive antibody (cPRA) (Table 1). Post-KAS, kidneys were more likely to experience cold ischemia time > 24 hours (20.0% vs 18.8%, p<0.001) and to be procured after cardiac death (21.5% vs 17.8%, p<0.001). Correspondingly, post-KAS kidneys had greater delayed graft function, defined by requiring hemodialysis within the first week post-transplant (28.7% vs 26.1%, p<0.001). Patient survival did not change post-KAS (KM log rank p=0.296). Competing risks modeling demonstrated a lower hazard of graft loss post-KAS, HR 0.90 (95% CI 0.84-0.97, p=0.007). Cumulative incidence function of graft loss is presented in Figure 2.
*Conclusions: Implementation of the KAS has allowed the use of higher-quality kidneys in younger, more sensitized recipients. Despite an increase in transplants for highly sensitized recipients, KA has resulted in a 10% reduction in hazard of graft loss. Longer follow-up and attention to organ discard practices are needed to quantify the long-term impact of the KAS system.
|Donor age > 60, n(%)||2,292 (8.6%)||2,299 (7.5%)||<0.001|
|Donor Diabetes, n(%)||2,168 (8.2%)||2,171 (7.1%)||<0.001|
|Donor Cause of Death, n(%)
|KDPR>85%, n(%)||2,272 (8.5%)||2,228 (7.3%)||<0.001|
|Recipient Age > 60, n(%)||9,869 (37.1%)||10,462 (34.1%)||<0.001|
|cPRA, Mean (SD)||16.9 (30.3)||19.5 (33.1)||<0.001|
|cPRA>80%, n(%)||2,617 (9.8%)||3,640 (11.9%)||<0.001|
To cite this abstract in AMA style:Samoylova ML, Shaw BI, Irish W, Kesseli SJ, Connor A, Barbas AS, McElroy L, Ravindra KV. Increased Graft Survival Following Implementation of the Kidney Allocation Score [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/increased-graft-survival-following-implementation-of-the-kidney-allocation-score/. Accessed December 1, 2023.
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