Introduction: NEAD chains raised concern that wait-listed blood type (BT) O patients and racial minorities would be disadvantaged by allocation of a non-directed donor (NDD) kidney to someone other than the wait-list (WL) candidate who would have been the top person on the deceased donor (DD) match run for that kidney.

Methods: We retrospectively examined candidates on the DD WL and Rs of DD, living donor (LD), and KPD kidney transplants (KTx) from January 1, 2000 – June 28, 2013 using OPTN STAR Files. Distributions of patient race, BT, and PRA within each of these cohorts was calculated as proportions using SAS. Differences in distributions of characteristics across Rs of each KTx type were compared by Chi-square. Separately, we modeled using DD as NEAD chain-initiating kidneys (DD-CIK) to produce chains using historical data from a KPD registry, the KTx WL and the OPTN STAR files covering DD KTx performed from May 18, 2010 and June 28, 2013. Only 2-way DD-CIK chains were allowed ending with the actual historical OPTN allocation R.

Results: The racial distribution of KPD Rs is more similar to LD than to DD. For example, black Rs comprise 14.2%, 14.1%, and 30.5% of KPD, LD and DD Rs. Similar to LD, KPD Rs were less likely than DD Rs to have BT-O (40.5% vs. 45.3%), but more likely to have BT-B (19.2% vs. 12.8%). However, while the percentage of BT O Rs and black Rs was less with KPD than with DD, the total number of BT O and black Rs transplanted per NDD was higher than would have been achieved through allocation of the NDD kidney utilizing the prior OPTN DD kidney allocation system. A higher proportion of Rs transplanted by KPD were sensitized than those transplanted by conventional LD and DD. Simulating the matching of historical OPTN DDs into a KPD registry to produce DD-CIK chains with two Rs, produced the following results: 329 DD kidneys out of 18,000 were utilized as DD-CIK. Instead of these 329 DD kidneys producing 329 KTx, 658 KTx were possible if DD-CIK were available to the KPD matching system, in addition to the 424 KTx achieved by traditional KPD alone.

Conclusion: NEAD chains have not disadvantaged BT O, black or highly sensitized patients. In a simulation, twice as many patients and more highly sensitized patients and BT O patients were transplanted through DD-CIK allocation than by the historical OPTN allocation used at the time.

CITATION INFORMATION: Rees M, Roberts J, Lentine K, Roth A, Leichtman A, Xiao H, Rafizadeh S, Neidich E, Melcher M. NEAD Chains Do Not Disadvantage Blood Type O, Black, or Highly Sensitized Patients. Am J Transplant. 2016;16 (suppl 3).

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