On December 4, 2014 the new Kidney Allocation System (KAS) went into effect in the United States. The intentions of KAS were to increase the allocation of organs to candidates with high PRA and with long exposure to dialysis. We sought to evaluate the impact of KAS on our center.

In order to analyze the impact of KAS and adjust for trends preceding it we categorized our decreased donor transplants by two years intervals between 2011 and 2016. We analyzed transplanted organs by: age of donors, DCD, KDPI, cold ischemic time, and incidence of DGF. Recipients caracteristics were: age, gender, race and ethnicity, dialysis status and duration, and PRA. Multivariable analysis was performed to identify factors associated with KAS or other independent factors.

The study cohort comprised of 1,302 transplants: 2011-12: 439 (34%); 2013-14: 533 (41%); 2015-16: 330 (25%). The main results of our analysis are shown in table 1.

There was a higher proportion of Hispanic, patients on dialysis, and high PRA recipient in the KAS era. However, mostly transplantation of Hispanics and exposure to dialysis were independently associated with KAS. A 3-fold increase in transplants of recipients with PRA > 90% was seen even in the pre-KAS era.

Our center experienced an increase in the mean age of donors, and in the proportion of DCD, and a decrease in the mean cold ischemic time, as compared to the immediate pre-KAS era. We have not seen an increase in the proportion of donors with extremes of KDPI scores. That was a trend towards a higher proportion of with DGF. However, this trend was present even before the pre-KAS era. In the KAS era DGF was associated with the increase utilization of DCD donors.

In summary, our center has experienced some of the changes intended by KAS (more transplants of sensitized recipients and those with longer dialysis exposure). However, the proportion of AA transplanted, cold ischemic time, or the utilization of organs at extremes of KDPI have not been significantly affected by KAS. The higher proportion of Hispanic recipients and DCD utilization was unexpected and deserves further investigation. .

CITATION INFORMATION: de Mattos A, Alnimri M, Chen L.-X, Sageshima J, Santhanakrishnan C, Perez R. Intended and Unexpected Impact of the New Kidney Allocation System on a Large Volume Transplant Program. Am J Transplant. 2017;17 (suppl 3).

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